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.

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

“…Of the 18 articles included in this study, 17 were retrospective studies, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]32 and one was prospective study. 26 The geographical distribution of the included studies was America (n = 4), 10,14,15,26 China (n = 3), 2,11,19 Canada (n = 2), 12,24 Japan (n = 2), 17,21 Korea (n = 2), 18,32 Romania (n = 2), 23,25 Italy (n = 1), 13 England (n = 1) 22 and India (n = 1). 16 For the 5101 patients, 2365 (46.4%) patients underwent SIH and 2736 (53.6%) patients underwent STH.…”

“…16 For the 5101 patients, 2365 (46.4%) patients underwent SIH and 2736 (53.6%) patients underwent STH. Of the 18 articles, 15 articles reported postoperative complications, [10][11][12][13][14][15][16][17][18][19][20][21][22][23]25 14 articles reported perioperative mortality [10][11][12][13][14][15][16][17][19][20][21][22][23]25 and 16 articles reported long-term survival after SIH or STH [10][11][12][13][15][16][17][18][19][21][22][23][24][25][26]32 (Tables 1 and 2). points, which were considered low risk of bias.…”

“…Table 2 shows the postoperative complications and perioperative mortality. We performed meta-analysis on 4307 patients for postoperative complications from 15 studies, [10][11][12][13][14][15][16][17][18][19][20][21][22][23]25 and 4099 patients for perioperative mortality from 14 studies. [10][11][12][13][14][15][16][17][19][20][21][22][23]25 In 14 studies, five studies reported the perioperative mortality was zero for both SIH and STH.…”

“…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.…”