Surgical management of patients with synchronous colorectal liver metastasis: A multicenter international analysis

Skye C. Mayo, Carlo Pulitano, Hugo Marques, Jorge Lamelas, Christopher L. Wolfgang, Wassila De Saussure, Michael A. Choti, Isabelle Gindrat, Luca Aldrighetti, Eduardo Barrosso, Gilles Mentha, Timothy M. Pawlik

Research output: Contribution to journalArticle

100 Scopus citations

Abstract

Background: The goal of this study was to investigate the surgical management and outcomes of patients with primary colorectal cancer (CRC) and synchronous liver metastasis (sCRLM). Study Design: Using a multi-institutional database, we identified 1,004 patients treated for sCRLM between 1982 and 2011. Clinicopathologic and outcomes data were evaluated with uni- and multivariable analyses. Results: A simultaneous CRC and liver operation was performed in 329 (33%) patients; 675 (67%) underwent a staged approach ("classic" staged approach, n = 647; liver-first strategy, n = 28). Patients managed with the liver-first approach had more hepatic lesions and were more likely to have bilateral disease than those in the other 2 groups (p < 0.05). The use of staged operative strategies increased over the time of the study from 58% to 75% (p < 0.001). Liver-directed therapy included hepatectomy (90%) or combined resection + ablation (10%). A major resection (>3 segments) was more common with a staged approach (39% vs 24%; p < 0.001). Overall, 509 patients (50%) received chemotherapy in either the preoperative (22%) or adjuvant (28%) settings, with 11% of patients having both. There were 197 patients (20%) who had a complication in the postoperative period, with no difference in morbidity between staged and simultaneous groups or major vs minor hepatectomies (p > 0.05). Ninety-day postoperative mortality was 3.0%, with no difference between simultaneous and staged approaches (p = 0.94). The overall median and 5-year survivals were 50.9 months and 44%, respectively; long-term survival was the same regardless of the operative approach (p > 0.05). Conclusions: Simultaneous and staged resections for sCRLM can be performed with comparable morbidity, mortality, and long-term oncologic outcomes.

Original languageEnglish (US)
Pages (from-to)707-716
Number of pages10
JournalJournal of the American College of Surgeons
Volume216
Issue number4
DOIs
StatePublished - Apr 2013

ASJC Scopus subject areas

  • Surgery

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    Mayo, S. C., Pulitano, C., Marques, H., Lamelas, J., Wolfgang, C. L., De Saussure, W., Choti, M. A., Gindrat, I., Aldrighetti, L., Barrosso, E., Mentha, G., & Pawlik, T. M. (2013). Surgical management of patients with synchronous colorectal liver metastasis: A multicenter international analysis. Journal of the American College of Surgeons, 216(4), 707-716. https://doi.org/10.1016/j.jamcollsurg.2012.12.029