6080 POSTER Strategy for Synchronous and Multiple Liver Metastasis

Considering the cost of a simultaneous versus staged approach to resection of colorectal cancer with synchronous liver metastases in a publicly funded healthcare model

“…With less than three metastases, staged resection caused lower morbidity but this difference failed to reach statistical significance . Similarly, Osada et al reported that patients with three or more metastases benefit from neoadjuvant chemotherapy followed by a staged hepatectomy. Likewise, Minagawa et al argue that patients with four or more colorectal lymph node metastases (>N2 status in the primary) may benefit from preoperative chemotherapy as opposed to upfront simultaneous surgery.…”

“…Multivariable negative binomial model evaluating predictors associated with increasing total cost of care With less than three metastases, staged resection caused lower morbidity but this difference failed to reach statistical significance 4. Similarly, Osada et al22 reported that patients with three or more metastases benefit from neoadjuvant chemotherapy followed by a staged hepatectomy. Likewise, Minagawa et al23 argue that patients with guidelines for which surgical approach should be perused and decisions are made on a patient by patient basis.…”

Strategies for Synchronous and Multiple Metastatic Liver Tumors Designed from Epithelial-Mesenchymal Transition Concept

“…Because simultaneous major hepatectomy was associated with severe morbidity rate (36.1% vs. 17.6%) and mortality (8.3% vs. 1.4%) [13], a staged operation for synchronous and multiple hepatic nodules has been recommended with a delay of at least 3 months after the primary resection. In contrast, based on the results of simultaneous resection to have similar operative times, intraoperative blood loss, and complications [11], recent studies showed simultaneous resection to enhance safety [3,14,15]. According to the safety concepts for such surgical procedures, simultaneous colorectal and liver resections have been evaluated as grade C under the recommended guidelines [16], however, no randomized trials have been published.…”

“…However, where curative resection is not performed for reasons such as the presence of tumors in other organs, chemotherapy should be selected first, and the timing of possible radical resection immediately planned [11].…”

“…Therefore, this review will primarily discuss treatments in association with the FOLFOX/FOLFIRI chemotherapeutic regimens. When arguing the timing of hepatectomy and whether it should be performed first or staged, the contents and results of recent chemotherapeutic developments should be considered [11]. In the present review, chemotherapeutic strategies involving FOLFOX or FOLFIRI and/or hepatectomy will be discussed from clinical data and EMT concept.…”