Background: The present study aimed to compare the perioperative safety and long-term survival of patients with synchronous colorectal liver metastases undergoing sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR). Methods: From January 2007 to December 2016, data from patients undergoing surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared. Results: A total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, P = 0.007) and the SeR group (16.3%, P =0.166). The overall survival at 1 and 3 years in the SeR group (93.9% and 50.1%) was lower than that in the DeR group (94.9% and 64.8%, P = 0.019), but not significantly different from that in the SiR group (93.0% and 55.2%, P = 0.378). Recurrence-free survival at 1 and 3 years in the SeR group (22.4% and 18.4%) was lower than that in the DeR group (43.9% and 24.2%, P = 0.033) but not significantly different from that in the SiR group (31.4% and 19.6%, P = 0.275). Cox multivariate analysis indicated that T4, lymph node-positive primary tumour, liver metastases >30 mm and SiR (compared with DeR) were correlated with poor prognosis. Conclusion: Simultaneous resection has a relatively higher incidence of severe complications, and with a staged resection strategy, the prognosis of delayed resection was better than that of sequential resection.

Background Local treatment remains the best option for recurrent colorectal liver metastasis. The current study aims to investigate predictive factors of survival outcomes and select candidates of local treatment for CRLM at first recurrence. Methods Data were collected retrospectively on CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution. A nomogram to predict overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index and calibration curve. Results Among 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated to be resectable and liver-limited disease. Among of them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients only received systemic chemotherapy. Multivariable analysis identified node-positive primary, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment were independent risk factors for survival outcome. Integrating these five variables, the nomogram showed good concordance statistics of 0.707. Compared with patients who only received systemic chemotherapy, radical local treatment did not improve survival outcome significantly (median OS: 21 vs. 15 months, p = 0.126) in high risk group (total score above 13). Conclusion Radical local treatment is crucial to prolong the survival of recurrent CRLM patients. The proposed model facilitates personalized assessment of prognosis for patients who developed first recurrence in liver.

Background: The present study aimed to compare the perioperative safety and long-term survival of patients with synchronous colorectal liver metastases undergoing sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR). Methods: From January 2007 to December 2016, data from patients undergoing surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared. Results: A total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, P = 0.007) and the SeR group (16.3%, P =0.166). The overall survival at 1 and 3 years in the SeR group (93.9% and 50.1%) was lower than that in the DeR group (94.9% and 64.8%, P = 0.019), but not significantly different from that in the SiR group (93.0% and 55.2%, P = 0.378). Recurrence-free survival at 1 and 3 years in the SeR group (22.4% and 18.4%) was lower than that in the DeR group (43.9% and 24.2%, P = 0.033) but not significantly different from that in the SiR group (31.4% and 19.6%, P = 0.275). Cox multivariate analysis indicated that T4, lymph node-positive primary tumour, liver metastases >30 mm and SiR (compared with DeR) were correlated with poor prognosis. Conclusion: Simultaneous resection has a relatively higher incidence of severe complications, and with a staged resection strategy, the prognosis of delayed resection was better than that of sequential resection.

Background: The present study aimed to compare perioperative safety and long-term survival of patients with synchronous colorectal liver metastases receiving sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR). Methods: From January 2007 to December 2016, data of patients receiving surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared. Results: A total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, p=0.007) and the SeR group (16.3%, p=0.166). Overall survival at 1-year and 3-year in the SeR group (93.9% and 50.1%) was lower than the DeR group (94.9% and 64.8%, p=0.019), but not statistically different compared with the SiR group (93.0% and 55.2%, p=0.378). Recurrence-free survival at 1-year and 3-year in the SeR group (22.4% and 18.4%) was lower than the DeR group (43.9% and 24.2%, p=0.033), but not statistically different compared with the SiR group (31.4% and 19.6%, p=0.275). Cox multivariate analysis indicated that T4, lymph node positive primary tumor, liver metastases>30mm and selective sequential resection (compared with delayed resection) were correlated with poor prognosis. Conclusion: Simultaneous resection has a relatively higher incidence of severe complication, and when staged resection strategy was made, the prognosis of delayed resection was better than that of sequential resection.