Surgical approaches of resectable synchronous colorectal liver metastases: Timing considerations

Vassiliou, Ioannis; Arkadopoulos, Nick; Theodosopoulos, Theodosios; Fragulidis, Georgios; Marinis, Athanasios; Kondi-Paphiti, A.; Samanides, Lazaros; Polydorou, Andreas; Gennatas, Constantine; Voros, Dionysios; Smyrniotis, Vassilios

doi:10.3748/wjg.v13.i9.1431

Cited by 59 publications

(56 citation statements)

References 26 publications

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“…In the patients undergoing staged resections, the metastases were generally larger and more numerous ( Table 2). There was a general tendency towards extending the criteria for synchronous resections over time, and the newer studies reported a greater number of major hepatectomies (more than three segments) in the more recent years [9][10][11][12]. For the reason of this clinical heterogeneity, no pooled estimates were undertaken.…”

Section: Resultsmentioning

confidence: 99%

Staged or simultaneous resection of synchronous liver metastases from colorectal cancer – a systematic review

2008

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Objective A systematic review of the literature was undertaken to estimate the differences in length of hospital stay, morbidity, mortality and long-term survival between staged and simultaneous resection of synchronous liver metastases from colorectal cancer to determine the level of evidence for recommendations of a treatment strategy.Method A Pub-med search was undertaken for studies comparing patients with synchronous liver metastases, who either had a combined or staged resection of metastases. Twenty-six were considered and 16 were included based on Newcastle Ottawa Quality Assessment Scale. All studies were retrospective and had a general bias, because the staged procedure was significantly more often undertaken in patients with left-sided primary tumours and larger, more numerous and bi-lobar metastases. Analyses of primary outcomes were performed using the random effects model.Results For the reason of the heterogeneity of the observational studies, no odds ratios were calculated. In 11 studies, there was a tendency towards a shorter hospital stay in the synchronous resection group. Fourteen studies compared total perioperative morbidity and lower morbidity was observed in favour of a combined resection. Fifteen studies compared perioperative mortality, which seemed to be lower with the staged approach. Eleven studies compared 5-year survival, which seemed to be similar in the two groups.Conclusion No randomized controlled trials were identified, and hence a meta-analysis was not performed. The evidence level is II to III with grade C recommendations. Synchronous resections can be undertaken in selected patients, provided that surgeons specialized in colorectal and hepatobiliary surgery are available.

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Section: Resultsmentioning

confidence: 99%

Staged or simultaneous resection of synchronous liver metastases from colorectal cancer – a systematic review

2008

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“…The 5-year survival after liver resection varies between 16% and 30% [5, 7–10]. The tumour recurrence rate after resection of hepatic metastases varies between 40.4% and 73.5% [11, 12].…”

Section: Introductionmentioning

confidence: 99%

Management of the Hepatic Lymph Nodes during Resection of Liver Metastases from Colorectal Cancer: A Systematic Review

2008

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Background. Hepatic lymph node involvement is generally considered a contraindication for liver resection performed for colorectal liver metastases. However, some advocate hepatic lymphadenectomy in the presence of macroscopic involvement and others routine lymphadenectomy. The aim of this review is to assess the role of lymphadenectomy in resection of liver metastases from colorectal cancer. Methods. Medline, Embase and Central databases were searched using a formal search strategy. Trials with survival data with a minimum follow-up of 1 year were considered for inclusion. Meta-analysis was performed using Revman. Results. A total of 4230 references were identified. Ten reports of nine studies including 926 patients qualified for the review. The prevalence of nodal metastases after routine lymphadenectomy was 16.3%. The overall 3-year and 5-year survival rates in node-positive patients were 9/151 (11.3%) and 2/137 (1.5%), respectively, compared to 3-year and 5-year survival rates of 424/787 (53.9%) and 246/767 (32.1%) in node-negative patients. The odds ratios for 3-year and 5-year survivals in node positive disease compared to node-negative disease were 0.12 (95% CI 0.06 to 0.24) and 0.08 (95% CI 0.03 to 0.22). There was no randomized controlled trial which assessed the survival benefit of routine or “selective” lymphadenectomy. Conclusion. Currently, there is no evidence of survival benefit for routine or selective lymphadenectomy. Survival rates are low in patients with positive lymph nodes draining the liver irrespective of whether they are detected by routine lymphadenectomy or by macroscopic involvement. Further trials in this patient group are required.

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“…Moreover, the need for only one operation improves the patient's comfort, reduces healthcare costs, and overall hospital stay [3,11] . Some studies have indicated that simultaneous resection of the colorectal primary lesion and hepatic metastasis is safe and acceptable [3,5,10,[26][27][28] . Martin et al [3] analyzed the severity of complications with both major and minor liver resections as well as similar colorectal procedures and found no statistical difference between the results from the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes after Simultaneous Colorectal and Major Hepatic Resection for Synchronous Colorectal Liver Metastases

Saiura²,

Arita³

et al. 2017

Dig Surg

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Background/Aims: Resection of the liver is the standard therapeutic approach for patients with hepatic metastasis and is the only therapy with curative potential. The optimal timing of surgical resection for synchronous metastases has remained controversial. Methods: From January 1993 to December 2008, our strategy has been to use simultaneous resection for resectable synchronous colorectal and liver metastases. During this period, 115 patients underwent simultaneous colorectal and hepatic resection. We evaluated the short-term outcomes of these patients by reviewing operative and perioperative clinical data. Results: In patients with simultaneous resection, there was no evidence of colorectal complications associated with major hepatectomy or no evidence of hepatic complications related to rectal resection. But increased hepatic complications were apparent with major hepatectomy compared with minor hepatectomy (44 vs. 7.2%, p < 0.001) and patients with rectal resection had increased colorectal complications (23% in the rectal resection vs. 5.3% in the colectomy group, p = 0.034). Conclusions: Simultaneous major hepatectomy and rectal resection can increase the hepatic or colorectal morbidity, respectively. These patients may be considered for staged resections.

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Surgical approaches of resectable synchronous colorectal liver metastases: Timing considerations

Cited by 59 publications

References 26 publications

Staged or simultaneous resection of synchronous liver metastases from colorectal cancer – a systematic review

Staged or simultaneous resection of synchronous liver metastases from colorectal cancer – a systematic review

Management of the Hepatic Lymph Nodes during Resection of Liver Metastases from Colorectal Cancer: A Systematic Review

Short-Term Outcomes after Simultaneous Colorectal and Major Hepatic Resection for Synchronous Colorectal Liver Metastases

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