Comparing Simultaneous Versus Staged Resection in Patients with Synchronous
Colorectal Liver Metastases: Case match study
Faisal Elagili, MD1. Ahmet Cem Dural, MD2. Muhammet Akyuz, MD2. Erman Aytac, MD1, Eren
Berber, MD2, FACS. Gokhan Ozuner, MD1, FACS, FASCRS.
Department of Colorectal Surgery 1, Digestive Disease Institute, Center for Endocrine Surgery
2
Cleveland Clinic, Ohio
Abstract
Background: There is no consensus on the optimal timing of liver resection in patients with
synchronous colorectal liver metastasis.
Patients and methods: Patients undergoing hepatic resections between 2004-2013 for
synchronous colorectal liver metastases were analyzed from a prospectively maintained and
IRB approved database. Patients who underwent simultaneous resection of a colorectal primary
and hepatic metastasis in a single operation (Group I) were case-matched 1:1with patients
who underwent staged operation (Group II) according to age, sex, ASA classification, size of
liver lesion and number of liver lesion.
Results: 66 patients (33 Group I, 33 Group II) were matched from a total cohort of 106 patients
with synchronous colorectal liver metastasis. The patients characteristics of both groups was
similar (Table).62% were male and the mean age was 55.5±11 years. Blood loss and duration
of surgery did not differ between simultaneous resections and staged resection (p=0.2; p=0.3,
respectively). Perioperative complication rate were similar in both groups (P=0.2). There was no
mortality. The mean number of in-hospital days during the course of treatment was 11 ± 4 days
in Group I and 12± 3 days in Group II (P 0.07).
There was no difference in 2 years disease free survival and overall survival were found
between Group I and Group II ( 30% and 31%, p= 0.5;62% and 71%,p=0.8 respectively) .
Conclusion: Simultaneous liver resections result in similar short and long –term outcomes as in
patients undergoing sequential resections for synchronous colorectal cancer with comparable
metastatic disease burden.
Table: Patients demographic and matching variables
Variables
Age,(y),median(range)
Gender
F
M
ASA
2
3
4
Size of liver metastases, mean(SD)
Number of liver metastases,
mean(SD)
Liver resection minor
Liver resection major
Pre-operative chemotherapy
Adjuvant chemotherapy
No treatment
Staged
(N=33)
54(35-74)
Simultaneous
(N=33)
55(27-82)
P-value
10(30%)
23(70%)
15(46%)
18(54%)
0.2
6(18%)
24(73%)
3(9%)
3.2± 1.8
2.3 ±1.4
4(12%)
27(82%)
2(6%)
3.4 ± 2.0
2.2 ±1.5
22/33(67%)
11/33(33%)
30/33 (91%)
3 /33 (10%)
0 /33
25/33(76%)
8/33(24%)
25/33 (76%)
4/33(12%)
4 /33 (12%)
0.6
0.9
0.9
0.6
0.1
0.1
0.3
0.3
0.3