Abstract
BACKGROUND. The choice type of surgery between staged and simultaneous operations remains an actual issue in patients with colorectal cancer with synchronous liver metastases. The aim of this prospective study is to compare Short-term outcomes of patients with synchronous colorectal liver metastases treated by simultaneous or staged surgery. METHODS. 172 suitable patients were treated in State Scientific Centre of coloproctology named after А.N. Ryzhih, Moscow, Russia between January 2013 and February 2017. Simultaneous colorectal and hepatic resections were performed in 128 patients; 44 patients underwent delayed hepatectomy. Short-term outcomes were compared in patients who underwent simultaneous colorectal and hepatic resection and staged surgery depending on the demographic, clinical and morphological characteristics and type of operations. RESULTS. Median size and number of metastases in the liver were significantly smaller in the group of simultaneous operations: 2.2 cm vs 3.2 cm (p=0.034) and 2 vs 3.5 (p=0.0001), respectively. Major liver resections were rarely performed in group of simultaneous operations: 20 % vs 61 % (р=0,0001). Mortality and complications rates were similar in both groups: 1 % vs 2% (p=0,98) and 30% vs 45 % (р=0,08), respectively. Median days after surgery were also similar in both groups: 14 (12-21) vs 14 (12-21) days, (р=0,6), respectively. Median bloodloss in cases of major liver resections in group of simultaneous operations was lower than in analogical group in staged surgery: 345 ml vs 900 ml (р=0,007), respectively. There was no difference in mortality and complications rates between major liver resections in both groups: 0 vs 4 % (p=0,98) and 52 % vs 48 % (p=1,0), respectively. Rates of acute hepatic insufficiency were similar in both groups of major liver surgery: 4 % vs 11 %, (p=0,36). Median inpatient days were also similar in both groups of major liver surgery: 19 (15-27) vs 19 (11-27) days (р=0,1), respectively. CONCLUSION. Simultaneous operations, requiring economical resections are indicated in cases of synchronous metastases of colorectal cancer in the liver. Simultaneous major liver surgery do not lead to increased bloodloss, complications, mortality rates and inpatient days regardless on type of colorectal surgery in cases of synchronous colorectal cancer liver metastases.
Highlights
The choice type of surgery between staged and simultaneous operations remains an actual issue in patients with colorectal cancer with synchronous liver metastases
Simultaneous colorectal and hepatic resections were performed in 128 patients; 44 patients underwent delayed hepatectomy
Short-term outcomes were compared in patients who underwent simultaneous colorectal and hepatic resection and staged surgery depending on the demographic, clinical and morphological characteristics and type of operations
Summary
Пономаренко А.А., Ачкасов С.И., Панина М.В., Рыбаков Е.Г. ФГБУ «ГНЦК им. Объем кровопотери при выполнении обширной резекции печени в группе симультанных операций был достоверно ниже, по сравнению с группой обширных резекций печени в качестве второго этапа хирургического лечения больных с синхронными метастазами колоректального рака в печени (медиана – 345 мл vs 900 мл, р=0,007). Продолжительность послеоперационного госпитального периода в группе симультанных обширных резекций печени не отличалась от таковой в группе обширных резекций печени в качестве второго этапа хирургического лечения больных с синхронными метастазами в печени (19 (15;27) койко-дней и 19 (11;27) койко-дней, р=0,1). Симультанные обширные резекции печени не сопровождаются увеличением интраоперационной кровопотери, не увеличивают частоту осложнений, летальности, продолжительность послеоперационного госпитального периода по сравнению с обширными резекциями печени в качестве второго этапа хирургического лечения больных колоректальным раком с синхронными метастазами в печени, вне зависимости от локализации первичной опухоли и характера операции на толстой кишке. [Ключевые слова: синхронные метастазы в печени, резекции печени, колоректальный рак, симультанные операции]
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