Analysis Of Clinical Surgical Treatment Of Synchronous Colorectal Cancer Liver Metastasis

Objectives:To investigate the efficacy of simultaneous liver metastasis surgery for colorectal cancer and to analyze the multiple factors of prognosis.At the same time,meta-analysis was used to compare the simultaneous and delayed liver metastases in patients with liver metastases from synchronous colorectal cancer.Clinical efficacy,choose a more appropriate treatment strategy for this type of patients.Methods:The clinical data of 47 patients with synchronous colorectal cancer liver metastases who were admitted between June 2013 and January2018 were retrospectively analyzed.The short-term and long-term effects of surgical treatment were observed.SPSS 22.0 statistical software was used to analyze the statistical survival and verify factors that affect prognosis.Moreover,PubMed,Medline,Embase,Cochrane Library and other electronic databases were used for systematic literature search.23relevant English documents published between January 2001 and December 2016 were collected,and relevant data indicators were extracted using RevMan5.3 software.The meta-analysis was performed on the medium random effects model and the fixed effect model.Results:All the 47 patients underwent simultaneous radical resection of colorectal cancer and liver metastases.All patients had no perioperative mortality.The postoperative complication rate was 34.0%（16/47）.The treatment is cured or significantly relieved.The overall survival rates of the whole group at 1,3,and 5 years were 87.2%,53.2%,and 14.9%,respectively,and the 1-,3-,and 5-year disease-free survival rates were80.9%,42.6%,and 8.5%,respectively.Statistical analysis indicated that the maximum diameter of the primary tumor,the degree of primary tumor differentiation,the maximum diameter of the liver metastases,the level of CA19-9 and CEA at the time of diagnosis and whether adjuvant chemotherapy were the most important factors affecting the survival of patients（p<0.05）.According to the inclusion and discharge criteria,23studies with a total of 4328 patients were retrospectively analyzed.There were no statistically significant differences in safety and efficacy-related parameters between the synchronous and delayed groups.The long-term survival rates of the two methods were similar.Patients who underwent delayed surgery were more likely to have liver metastases in both lobe,and patients who underwent simultaneous resection were hospitalized for a 6-day reduction（p<0.05）.Conclusion:It is safe and effective to perform radical resection of colorectal cancer and liver metastases as much as possible while ensuring R₀ resection.However,it is necessary to ensure that the remaining liver meets the physiological needs of the body’s metabolism.Compared with staging,simultaneous resection is associated with shorter hospital stays without adversely affecting perioperative morbidity or long-term survival.