Simultaneous resection of primary colorectal cancer and synchronous liver metastases

Kleive D, et al. Simultaneous Resection of Primary Colorectal Cancer and Synchronous Liver Metastases: Contemporary Practice, Evidence and Knowledge Gaps. Oncol Ther. 2021 Jun;9(1):111-120. Free full-text.

Key Summary Points

  • High-level evidence in simultaneous resection of colorectal cancer and colorectal liver metastasis remains scarce.
  • Simultaneous resections may be considered in patients with good performance status and limited liver tumour burden.
  • Simultaneous resections should be avoided when requiring major liver resection and major colorectal resection.
  • Treatment strategies should be made by a multidisciplinary team.
  • Simultaneous resections should be performed as part of a clinical trial.

Bogach J, et al. Simultaneous versus staged resection for synchronous colorectal liver metastases: A population-based cohort study. Int J Surg. 2020 Feb;74:68-75. Free full-text.

Results: Among 2,738 patients undergoing resection for colorectal cancer liver metastases, 1168 (42%) had synchronous disease. Of these, 442 resections were simultaneous (38%) and 776 were staged (62%). The proportion of synchronous disease among patients undergoing resection increased on average 3% per year (p = 0.02). For simultaneous versus staged resection, respectively, median length of hospital stay was shorter (8 vs. 11 days, p < 0.001); rate of major liver resections was lower (17% vs. 65%, p < 0.001), major postoperative complications were similar (28% vs. 23%, p = 0.067), and 90-day post-operative mortality was higher (6% vs. 1%, p < 0.001). Chemotherapy was administered more commonly among patients undergoing staged resections (91% vs. 76%, p < 0.001). Simultaneous resection was associated with a lower median overall survival (40 months, 95%CI 35-46 vs. 78 months, 95%CI 59-86). Risk factors for lower survival included higher comorbidities, right-sided primary and simultaneous resection.

Conclusion: Simultaneous resection was associated with similar postoperative complications, higher postoperative mortality and poorer long-term survival. Prospective randomized trials can inform the role of simultaneous versus staged resection for synchronous colorectal cancer liver metastases.

See also: Simultaneous vs staged colorectal and hepatic resections

More PubMed results on comparison of simultaneous and staged resections.

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