Comparison Of The Safety And The Clinical Efficacy Of Simultaneous Resection Versus Staged Resection For Synchronous Colorectal Liver Metastases

Partâ… Studying the safety and the clinical efficacy of simultaneous versusstaged resection for synchronous colorectal liver metastases: aMeta-analysisBackground and Aims There is no clear consensus on the optimal timing of surgicalresection for synchronous colorectal liver metastases (SCLMs). The aim of thismeta-analysis is to compare the safety and the clinical efficacy of simultaneous withstaged resection of synchronous liver metastases from colorectal cancer, so may be toprovide an available evidence for the management of synchronous liver metastases fromcolorectal cancer.Methods Systematic review and meta-analysis of trials comparing outcomesfollowing simultaneous resection with staged resection for SCLM published from1990to2010in PubMed, Embase, Ovid and Medline. Study selection, study quality assessedand data extraction were all conducted independently by two reviewers anddiscrepancies between them were settled through consensus discussion. The meta-analysis was performed using the Review Manager (RevMan) software, version5.1.Results According to the criteria for inclusion and exclusion, ultimate there werenineteen nonrandomized controlled trials (NRCT) studies were included in this analysis.These studies included a total of3129patients:1116underwent simultaneous resectionand2013underwent staged resection. Meta-analysis showed that lower totalcomplications rate (OR=0.74,95%CI:0.62~0.88, P<0.001) and shorter hospital stay(WMD=-5.04,95%CI:-6.80~-3.29, P<0.001) were observed in simultaneous resection group. No significant difference was observed between simultaneous and stagedresection group in terms of blood loss (WMD=-162.96,95%CI:-331.32~5.40, P=0.06),operative time (WMD=-15.28,95%CI:-76.28~45.72, P=0.62) and the patient need toblood transfusion in operation (OR=1.27,95%CI:0.91~1.76, P=0.16). The overallsurvival rate in the simultaneous resection group did not statistically differ with that inthe staged resection group at1year (OR=0.73,95%CI:0.48~1.09, P=0.13),3years(OR=1.15,95%CI:0.90~1.46, P=0.26),5years (OR=1.12,95%CI:0.88~1.42, P=0.38);as well as the1,3and5years disease-free survival rates (respectively OR=0.64,95%CI:0.15~2.77, P=0.55; OR=0.59,95%CI:0.28~1.24, P=0.16; OR=0.61,95%CI:0.33~1.13, P=0.12), and also no significant difference was noted between thetwo group in terms of mortality (OR=1.58,95%CI:0.84~2.96, P=0.16).Conclusions Simultaneous liver resection can be undertaken in selected patients withSCLM and it is safe and efficient while avoiding a second laparotomy. In appropriatelyselected patients who can tolerant colorectal primary and metastatic liver lesionsoperation and without extrahepatic metastases, simultaneous resection might beconsidered as the preferred approach. Compared with staged liver resection group, therewas a lower overall morbidity in simultaneous group and no significantly difference wasobserved between the two groups in terms of overall survival rates and disease-freerates at1year,3years and5years. Due to the incorporation researches are all nonrandomized studies and there is lack of enough detailed information to make subgroupanalysis, therefore, better designed, adequately powered studies are required toinvestigate the safety and the clinical efficacy of simultaneous resection and toinvestigate the optimal timing of liver resection in patients with synchronous livermetastases from colorectal cancer. Only in this way can we provide meaningfulguidance for surgeons.Part â…¡ Comparison between simultaneous resection and staged resectionfor synchronous colorectal liver metastases Background and Aims Liver metastasis is one of the factors that affect the survivaland prognosis of colorectal cancer patients, surgery is still the most effective treatment.But the rationality of simultaneous resection is controversial. This article is toretrospective study of clinical data, to analyze the safety and efficacy of simultaneousresection, to explore the impact of different surgical strategies on the prognosis ofpatients with colorectal liver metastases, so as to provide reliable basis for the choice oftiming of surgery in patients with synchronous colorectal liver metastases.Methods From2000to2010,136patients with synchronous liver metastases fromcolorectal cancer were treated with operation in Shanghai East Hepatobiliary SurgeryHospital,55patients underwent simultaneous resection,81patients underwent stagedresection. We compared the morbidity, mortality, hospital duration, survival rate andmedian survival time between the two groups.Results The occurrence rates of postoperative complications for simultaneousresection was23.4%and18.7%in staged resection group (P=0.469). There was oneoperation-related death in simultaneous resection group and no occurred in staged group.The mean hospital duration was16.8days in simultaneous group and18.2days instaged group (P=0.053). The1-,3-and5-year survival rates were87.3%,55.2%and28.7%, respectively, in simultaneous group and89.9%(P=0.602),50.9%(P=0.653)and24.6%(P=0.461), respectively, in staged group. The median survival time was41months in simultaneous group and38months in staged resection group (P=0.168).Conclusion synchronous liver and colorectal resection is safety and preferred inselected patients.