Surgery for Synchronous Colorectal Liver Metastases in 233 Consecutive Patients: Which One of the Three Different Strategies?

Abstract

Introduction: This study aimed to investigate the surgical management and outcome of patients with primary colorectal cancer (CRC) and synchronous colorectal liver metastases (SCLM). Method: Consecutive patients undergoing surgical treatment of CRC and SCLM between 2000 and 2019 were identified retrospectively from a prospectively collected database. Three surgical strategies were followed: the simultaneous resection (SR), the colorectal-first (CRF) and the liver-first (LF) approach. Results: Of 233 patients, SRs were performed in 83 (35.6%) patients. CRF was used in 136 (58.4%) patients and 14 (6.0%) patients underwent LF. Overall morbidity was present in 102 (43.75%) patients and did not reach statistical significance among approaches. Bleeding grade B/C was observed in 30 (12.9%) patients. The difference among approaches ((9.6%), 17 (12.5%) and 5 (35.7%)) reached statistical significance (P=0.026). Liver failure grade B/C was observed in 24 (10.3%) patients. The difference among approaches (5 (6.0%), 14 (10.3%) and 5 (35.7%)) was statistically significant (P=0.003). Mortality included 8 (3.4%) patients; 1 (1.2%) in SR, 5 (3.7%) in CRF and 2 (14.3%) in LF (P=0.044). On the overall survival analysis, the SR approach has statistically significantly (P=0.006) longer survival (48.5 months vs. 32.7 months in CRF or 23.8 months in LF). Conclusions: treatment strategy should be patient-tailored. SR is feasible when both diseases require limited surgical procedures. CRF is recommended when concurrent major hepatectomy and colorectal resections may increase postoperative morbidity and mortality. LF approach diminishes the risk of metastatic progression during the treatment of the CRC.