Simultaneous versus staged resection for synchronous colorectal cancer liver metastases
| Autor: | Robert C.G. Martin, Vedra A. Augenstein, Kelly M. McMasters, Charles R. Scoggins, Nathan P. Reuter |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Colorectal cancer medicine.medical_treatment Adenocarcinoma Metastasis Neoplasms Multiple Primary Laparotomy Medicine Hepatectomy Humans Laparoscopy Colectomy Aged Aged 80 and over medicine.diagnostic_test business.industry Liver Neoplasms Perioperative Length of Stay Middle Aged medicine.disease Surgery Treatment Outcome Multivariate Analysis Female Complication business Colorectal Neoplasms |
| Zdroj: | Journal of the American College of Surgeons. 208(5) |
| ISSN: | 1879-1190 |
| Popis: | BACKGROUND: The aim of this study was to compare postoperative outcomes of patients with synchronous colorectal liver metastases treated with either simultaneous or staged colectomy and hepatectomy. STUDY DESIGN: From July 1997 to June 2008, a review of our 1,344-patient prospective hepato-pancreaticobiliary database identified 230 patients treated surgically for primary adenocarcinoma of the large bowel and synchronous hepatic metastasis. Clinicopathologic, operative, and perioperative data, complications, and grade of complications (grade 1, minor, to grade 5, death) were reviewed to evaluate selection criteria, operative methods, and perioperative outcomes. Chisquare and proportional hazard model were used to evaluate predictors of outcomes. RESULTS: Seventy patients underwent simultaneous resection of colon primary and liver metastasis in a single operation; 160 patients underwent staged operations. Simultaneous resections were similar for size (median 4 cm versus 3.7 cm) and number (median 3 cm versus 3 cm) of liver metastases. Major liver resections (3 Couinaud segments) were similar between staged and simultaneous (32% versus 33%, respectively), as was type of colectomy (p 0.2). Complication rates and severity were similar in both groups: 39 of 70 patients (56%) in the simultaneous groupexperienced63complicationsversus88of160patients(55%)with162complicationsin the staged group (p 0.24). Multivariate analysis identified blood transfusion as a predictor of complication (odds ratio 2.98, p 0.001). Patients having simultaneous resection required fewer days in the hospital (median 10 days versus 18 days, p 0.001). CONCLUSIONS: By avoiding a second laparotomy, simultaneous colon and hepatic resection reduces overall hospitalstay,withnodifferenceinmorbidityandmortalityratesorinseverityofcomplications, comparedwithstagedresection.Simultaneousresectionisanacceptableoptioninpatientswith resectable synchronous colorectal metastasis. (J Am Coll Surg 2009;208:842–852. © 2009 by the American College of Surgeons) Synchronous liver metastasis, commonly defined as liver metastasis occurring within 12 months of the colon primary, represents 13% to 25% of 90,000 newly diagnosed colorectal liver metastases. 1,2 Through the expansion of multidisciplinary care with advances in surgical training, surgical techniques (laparoscopy and ablation), anesthetic management, and chemotherapy, the overall survival of |
| Databáze: | OpenAIRE |
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