Staged or Simultaneous Surgery for Colon or Rectal Cancer with Synchronous Liver Metastases: Implications for Study Design and Clinical Endpoints

Yaqub, Sheraz; Margonis, Georgios Antonios; Søreide, Kjetil

doi:10.3390/cancers15072177

Cited by 3 publications

(3 citation statements)

References 41 publications

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“…In group B were hepatectomy is performed the rearrangement of the patient's position takes less time. We use the Pringle maneuver to control liver inflow [16][17][18][19][20][21]. Although, sometimes lower volume may is observed which causes circulatory disorders in organs, and therefore performing the Pringle should be used only when necessary.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Resection for Colorectal and Liver Metastases, new equipment and personalized medicine

Zarogoulidis,

Ioannidis,

Vagionas

et al. 2024

J. Cancer

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Nowadays we perform synchronous colorectal cancer resection along with synchronous liver metastases. We investigated whether colon resection first is safer than liver resection first and if simultaneous surgeries are in general safe. Patients and Methods: Twenty patients were included in our multicenter study. In our study patients had simultaneous laparoscopic resection of primary colorectal cancer and liver metastases. The patients included were divided into two groups based on their first surgery. Group A had colon resection first (n = 10) and group B had liver resection first (n = 10). All adverse effects and outcomes were compared after the first day of hospitalization. Results: The only difference between the two groups was the operative blood loss. It was observed to be less in group B. Conclusion:In our study we did not observe any significant difference regarding the order of the operation.

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Section: Discussionmentioning

confidence: 99%

Simultaneous Resection for Colorectal and Liver Metastases, new equipment and personalized medicine

Zarogoulidis,

Ioannidis,

Vagionas

et al. 2024

J. Cancer

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“…Various strategies exist regarding both the timing and extent of surgery. Regarding timing, the choice between simultaneous or staged resection for SCLM is subject to ongoing debate, with no established consensus on the criteria for surgery or the optimal timing for such interventions [3,6,7,9].…”

Section: Discussionmentioning

confidence: 99%

“…Each strategy aims to optimize outcomes by considering the most effective sequence for tumor removal. However, the current data do not decisively endorse any of these methodologies, and there is still a lack of international consensus regarding the preferred surgical treatment [3,6,7,9].…”

Section: Introductionmentioning

confidence: 90%

Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review

Milazzo,

Todeschini,

Caimano

et al. 2024

Cancers

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Surgical resection is the gold standard for treating synchronous colorectal liver metastases (CRLM). The resection of the primary tumor and metastatic lesions can follow different sequences: “simultaneous”, “bowel-first”, and “liver-first”. Conservative approaches, such as parenchymal-sparing surgery and segmentectomy, may serve as alternatives to major hepatectomy. A comprehensive search of Medline, Epistemonikos, Scopus, and the Cochrane Library was conducted. Studies evaluating patients who underwent surgery for CRLM and reported survival results were included. Other secondary outcomes were analyzed, including disease-free survival, perioperative complications and mortality, and recurrence rates. Quality assessment was performed using the AMSTAR-2 method. No significant differences in overall survival, disease-free survival, and secondary outcomes were observed when comparing simultaneous to “bowel-first” resections, despite a higher rate of perioperative mortality in the former group. The 5-year OS was significantly higher for simultaneous resection compared to “liver-first” resection. No significant differences in OS and DFS were noted when comparing “liver-first” to “bowel-first” resection, or anatomic to non-anatomic resection. Our umbrella review validates simultaneous surgery as an effective oncological approach for treating SCRLM, though the increased risk of perioperative morbidity highlights the importance of selecting suitable patients. Non-anatomic resections might be favored to preserve liver function and enable future surgical interventions.

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Liver-first approach in surgical treatment of colorectal cancer with synchronous liver metastases: results of a single-center study

Mesheryakova,

Trifanov,

Chernichenko

et al. 2024

Russian Journal of Oncology

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Relevance. At the time of initial detection of colorectal cancer after further examination, synchronous metastatic liver damage is determined in 20-25% of patients. The approach in which liver resection is performed as the first stage is called "liver-first approach" in the English literature. The rationality of this approach is justified by the eradication of the most prognostically significant tumor focus corresponding to hepatic metastasis, with the possibility of subsequent treatment of primary colorectal tumor. Goal. To evaluate the immediate and long-term results of treatment of patients with metastatic colorectal cancer using an approach focused on surgical treatment of synchronous metastatic foci in the liver by the first stage. Materials and methods. The study was carried out in the design of a single–center observational prospective cohort study in the period from February 2017 to June 2023 on the basis of the abdominal surgical department of the P. A. Herzen Moscow State Medical Institute - a branch of the Federal State Budgetary Institution "NMIC of Radiology" of the Ministry of Health of Russia. The study included 70 patients (37 men and 33 women in a ratio of 1:1). Results. The treatment plan, according to the previously approved protocol, was carried out in 25 patients out of 70, which was 35.7%. The average duration of the first stage of surgery was 235 minutes (from 125 to 328 minutes), the average volume of blood loss was 450 ml (from 100 ml to 1300 ml). The average number of hospital stays was 17 bed days (from 12 to 21 bed days). The 30-day mortality rate was 12.8% (5/39). Overall survival in terms of 1 and 3 years after the end of the second stage of surgical treatment was 78% and 52%, respectively. At the same time, the 1-year progression-free survival rate was 25%, and the 3-year survival rate was 11%. Conclusion. In rare clinical situations, when synchronous bilobar metastatic liver damage is combined with an asymptomatic tumor, the best choice is to follow the "liver-first" protocol. However, it should be remembered that not every patient at stage IV of the oncological process, due to the peculiarities of his somatic status and the high risk of disease progression, can be a candidate for combined two-stage treatment.

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Staged or Simultaneous Surgery for Colon or Rectal Cancer with Synchronous Liver Metastases: Implications for Study Design and Clinical Endpoints

Cited by 3 publications

References 41 publications

Simultaneous Resection for Colorectal and Liver Metastases, new equipment and personalized medicine

Simultaneous Resection for Colorectal and Liver Metastases, new equipment and personalized medicine

Surgical Resection in Colorectal Liver Metastasis: An Umbrella Review

Liver-first approach in surgical treatment of colorectal cancer with synchronous liver metastases: results of a single-center study

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