Short-term and long-term outcomes after simultaneous resection of colorectal malignancies and synchronous liver metastases

Abstract

Background: We evaluated the simultaneous resection of colorectal malignancies and synchronous liver metastases.

Methods: Between June 1982 and June 2006, a total of 752 patients underwent resection of colorectal hepatic metastases. In all, 185 (25%) of them underwent simultaneous resection of the hepatic lesions and the corresponding primary tumors.

Results: The median hospital stay was 8 days (range 4-24 days), with a median operating time of 4 h (range 2-8 h). Altogether, 62 (33.5%) patients required intraoperative transfusion of packed red blood cells (median 2.1 IU, range 1-5 IU), and 25 (13.5%) were given frozen fresh plasma (median 2.1 IU, range 1-4 IU). The morbidity rate was 20.5%. There were two postoperative deaths (mortality rate 1.08%) within 30 days of the surgical intervention. Major hepatectomy was associated with greater morbidity (37.2% vs. 16.2%, P < 0.01) and mortality (4.7% vs. 0%, P < 0.05) rates. For the overall survivals (OS) at 3 and 5 years were 60.1% (52.3-67.85%) and 36.1% (27.4-44.8%), respectively. Disease-free survivals (DFS) at 3 and 5 years were 37.7% (30.2-45.3%) and 26.5% (18.7-34.3%), respectively. Transfusion of blood products, CEA level > or = 200 ng/dl, and N2 node status were found to be prognostic factors by univariate analysis. CEA level > or = 200 ng/dl and N2 node status achieved prognostic significance by multivariate analysis.

Conclusions: The simultaneous resection of colorectal malignancies and synchronous liver metastases is safe, avoids an additional intervention, can be performed with low morbidity and mortality, and is associated with good oncologic outcomes. Node stage N2 and CEA level > or = 200 ng/dl should be given special consideration when selecting patients.