Role of Surgical Approach to Synchronous Colorectal Liver Metastases: A Retrospective Analysis

Abstract

Purpose: This study is a retrospective analysis of exploring the efficiency of surgical management on patients with synchronous colorectal liver metastasis (SCLM).

Patients and methods: Nine hundred fifty-three consecutive patients with SCLM from Weifang People's Hospital of Shandong Province between January 2006 and December 2015 were reviewed. The values of different factors were analyzed, such as different surgical indications of liver metastases, simultaneous or staged resection of primary colorectal cancer and liver metastases, and primary tumor resection (PTR) of asymptomatic patients with unresectable liver metastases.

Results: Median survival time (47.3 months) and 5-year survival rate (31%) for patients with resected liver metastases were significantly superior to that of with nonoperative treatment (17.2 months, 4%, P<0.001); enlarging the standard of liver metastases resection can improve the resection rates (31.0% vs 13.6%, P<0.001); for patients with resectable liver metastases, the in-hospital cost for simultaneous resection group was lower than that in the staged resection group (36,698 vs 45,134 RMB, P<0.001); for patients of the asymptomatic primary tumor with unresectable liver metastases, PTR was associated with improved median survival (18.0 vs 15.0 months, P=0.006).

Conclusion: For patients with SCLM, liver resection is considered the best treatment; expanding indications of liver resection can improve the resection rates. Simultaneous resection of the primary tumor and liver metastases were indicated in patients with resectable SCLM; PTR was recommended for asymptomatic patients with unresectable hepatic metastases.

Keywords: primary tumor resection; surgical treatment; survival analysis; synchronous colorectal liver metastases.

Figure 1

Flowchart of the study. A total of 953 patients with synchronous colorectal liver metastases were included, 252 of them received liver resection and 701 received non-surgical treatment.

Figure 2

Overall survival of patients with different surgical indications between 2006–2010 and 2011–2015. The overall survival of patients (A) with synchronous colorectal liver metastases (C) with liver metastases non-resection in 2011–2015 was higher than that in 2006–2010. (B) The overall survival of patients with liver metastases resection was no significant difference between 2006–2010 and 2011–2015.

Figure 3

Overall survival of patients with primary colorectal cancer and liver metastases undergoing simultaneous or staged resection. No significant differences could be detected in the overall survival between simultaneous resection group and staged resection group.

Figure 4

The impact of primary tumor resection on overall survival in patients with asymptomatic colorectal cancer and unresectable liver metastases. Primary tumor resection had better survival compared with those patients without primary tumor resection.

Figure 5

Overall survival of different treatment strategies for liver metastases. (A) The survival of patients with liver metastases resection was significantly better than that of patients without liver metastases resection. (B) The overall survival of patients with resectable liver metastasis and those with initially unresectable liver metastases were better than those with non-surgical treatment. However, there was no significant difference between patients with initially unresectable liver metastases and those with liver metastasis that could be resected initially.