Simultaneous resection of synchronous colorectal liver metastases provides similar overall survival rates as delayed resection

Abstract

Aims: The optimal surgical approach to synchronous colorectal liver metastases it was not standardized, yet. Although it was proved that the morbidity and mortality rates after simultaneous and delayed resection are similar, the survival rates achieved by these approaches still represent a subject of debate. This study compares the overall survival rates achieved by patients who underwent simultaneous resection or delayed resection. Methods: All the patients undergoing liver resection with curative intent, between 1995 and 2014, for liver only synchronous colorectal metastases were included in this study. The survival rates achieved by simultaneous resection and delayed resection, respectively, were compared by using Log-rank test. Results: Of 238 patients undergoing hepatectomy for synchronous colorectal metastases, 193 (81%) underwent simultaneous resection and 45 (19%) underwent delayed resection. The morbidity and mortality rates were not statistical significantly higher in patients undergoing simultaneous resection (p value > 0.05). The 1-, 3- and 5-year overall rates achieved by simultaneous resection (85.7%, 50.1% and 30.4%, respectively) were similar to those observed in delayed resection group (87.7%, 63% and 29.7%, respectively - p value = 0.817). The differences in survival rates were not statistically significant even in patients with rectal tumors (p value = 0.693), presenting locally advanced primary tumors - T3/T4 (p value = 0.957), positive lymph nodes (p value = 0.519) or more than 3 metastatic lymph nodes - N2 (p value = 0.801), multiple liver metastases (p value = 0.221), metastases larger than 5 cm (p value = 0.454), or undergoing major liver resections (p value = 0.979). Conclusions: Simultaneous resection provides similar survival rates as delayed resection, even in N-positive patients or those with primary rectal tumors, locally advanced colorectal tumors, multiple metastases or undergoing major hepatectomies.