Simultaneous Resection for Synchronous Colorectal Liver Metastasis: the New Standard of Care?

Abstract

Simultaneous resection was found to be equally as safe as staged resection even when evaluating patients undergoing more complex operations, and led to lower health care utilization. Under appropriate clinical circumstances, simultaneous resection offers benefits to patients and the health care system and should be the recommended surgical approach.

Treatment sequencing for simultaneous colorectal liver metastases

“…Along with increased adoption of parenchyma-sparing liver resections, there has been increased utilization of minimally invasive surgical approaches for both the primary tumor and liver metastases. [59][60][61] The CLASSIC and COST trials showed similar postoperative complication rates and recurrence rates for colon resections regardless of operative approach; with the benefit of shorter hospital stay and similar qualityof-life scores. 62,63 Similarly, increased adoption of laparoscopic hepatectomy is associated with lower complication rates and reduced combined with minor hepatectomy (partial lobectomy or left hepatectomy), the overall 30-day major morbidity rate was 26% and the 30-day mortality rate was 1.4%.…”

“…Along with increased adoption of parenchyma‐sparing liver resections, there has been increased utilization of minimally invasive surgical approaches for both the primary tumor and liver metastases . The CLASSIC and COST trials showed similar postoperative complication rates and recurrence rates for colon resections regardless of operative approach; with the benefit of shorter hospital stay and similar quality‐of‐life scores .…”

“…The OSLO‐COMET trial excluded patients with intact primary tumors, so the clinical significance and outcomes of minimally invasive combined resection remain poorly characterized. In population‐based studies, the proportion of patients undergoing minimally invasive combined resections is 12%, underscoring the importance of patient selection for these procedures …”

“…The OSLO-COMET trial excluded patients with intact primary tumors, so the clinical significance and outcomes of minimally invasive combined resection remain poorly characterized. In population-based studies, the proportion of patients undergoing minimally invasive combined resections is 12%, underscoring the importance of patient selection for these procedures 61. 6 | TREATMENT SEQUENCE6.1 | Combined vs staged approachesThe published data consistently show decreased total operative time and hospital stays with a similar or increased risk of postoperative complications when patients undergo combined liver and colorectal resections relative to staged (colon-first or liver-first) resections, with similar survival outcomes.…”

Combined Proctectomy and Hepatectomy for Metastatic Rectal Cancer: Safe for the Fit and Able—But for Everyone?

“…This approach was associated with a significantly shorter length of stay and significantly decreased healthcare utilization in the simultaneous resection cohort. 5 However, C-PH continues to be a somewhat controversial practice, with variable clinical outcomes demonstrated in the literature. 6,7 Notably, a prospective pilot study (RESECT) is currently underway, and was designed to assess 90-day postoperative complication rate, postoperative 90-day mortality, quality of life at 3 months, and healthcare utilization in patients diagnosed with synchronous colorectal liver metastasis undergoing a simultaneous colorectal and liver resection (including major liver resections).…”