Comparison of sequential, delayed and simultaneous resection strategies for synchronous colorectal liver metastases

Abstract

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.

First 100 minimally invasive liver resections in a new tertiary referral centre for liver surgery

“…As such, a recent analysis by Wang et al . [ 20 ] found that the incidence of severe complications was doubled after synchronous resection (26.7%) when compared with the delayed liver resections (11.2%).…”

Colorectal Cancer, Liver Metastases and Biotherapies

“…(2) delayed resection (DeR) in which we deliver interval chemotherapy between staged colonic cancer resection and hepatic resection of CRC metastases; and (3) simultaneous resection (SiR), single-stage resection of primary colorectal cancer and liver metastases simultaneously. SiR is performed in patients who fulfil certain criteria (1) the primary tumour was located in the right colon regardless of the tumour disease burden of liver metastases; (2) the tumour disease burden was not heavy, and the tumour number was less than two if the primary tumour was located in the left colon or rectum [38,39].…”

Simultaneous versus staged major hepatectomy (≥3 liver segments) for outcomes of synchronous colorectal liver metastases: A systematic review and meta‐analysis

“… 9 , 10 However, the timing of surgery remains controversial. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Some studies suggested that SIH could increase the risk of postoperative complications and perioperative mortality, 11 , 12 , 13 while other studies did not support this conclusion. 14 , 15 , 16 In addition, the difference in long‐term survival is also unclear between the SIH and STH.…”

“…However, articles on major hepatectomy in SIH have significantly increased in the past decade. 10 , 11 , 12 , 13 , 14 , 15 , 20 , 21 , 22 , 23 , 24 , 25 , 26 Whether more patients received major hepatectomy can lead to differences in postoperative complications and perioperative mortality between simultaneous major hepatectomy (SIMH) and staged major hepatectomy (STMH) is unclear. And no meta‐analysis has been performed to investigate this issue.…”