Combined liver and colorectal resections for synchronous metastases is safe and efficient when performed at a quaternary referral center

Abstract

Presenter: Kevin Choong MD | City of Hope Cancer Center Background: The operative sequencing for patients with resectable synchronous colorectal liver metastases remains controversial. Retrospective institutional studies have shown relative safety and lower lengths of stay in combined versus staged resections. National database studies, however, have reported increased morbidity with combining major liver resection with concurrent colorectal resections. This has led to questions regarding this approach, especially in non-specialized centers. In this study, we hypothesize that combined colorectal and liver resections for synchronous metastases is both safe and efficient. Methods: A retrospective review of combined resections for synchronous colorectal liver metastases at a quaternary referral center from 2015-2020. Clinicopathologic and perioperative data was collected. Univariate and multivariate analyses were performed to identify risk factors for major post-operative complications. Results: One hundred one patients were identified, with 35 undergoing major liver resections (>3 segments) and 66 undergoing minor liver resections. Primary tumors were in the right colon in 20 (19.8%), the left colon in 57 (56.4%), and the rectum in 24 (23.8%). Patients who underwent minor liver resection had higher BMI (27.1 vs. 24.6, p = 0.04) and were more likely to be ASA 4 (36.3% vs. 17.1%, p = 0.04). Locoregional stage of the primary colorectal cancer did not differ between major and minor liver resections. The vast majority of patients (94%) received neoadjuvant therapy and there was no significant difference in the duration or regimen between those undergoing major or minor liver resection. Major liver resections were more likely to receive blood transfusions (28.6% vs. 9.1%, p = 0.01). However, estimated blood loss (433.4 ml vs. 352.2 ml, p = 0.19), case duration (451.9 min vs. 481.4 min, p = 0.27), and length of stay (9.7 days vs. 8.0 days, p = 0.18) were no different between major and minor liver resection. Post-operatively, patients undergoing major liver resection had higher rates of post-hepatectomy liver failure (34.2% vs. 7.6%, p = 1 (p1, no factors were associated with significantly increased odds of major complication. Conclusion: Combined resection for synchronous colorectal liver metastases when performed at a quaternary referral center is both safe and efficient.