WASHINGTON -- Simultaneous resection of a colorectal lesion and a small hepatic metastasis is safe, but when the liver lesion is more extensive separate procedures may be the better course, a multicenter group found.
WASHINGTON, March 19 -- Simultaneous resection of a colorectal lesion and a small hepatic metastasis is safe, but when the liver lesion is more extensive separate procedures may be the better course, a multicenter group found.
"We looked at factors including surgical complications and survival data among the groups and found that in certain patient groups, simultaneous surgery was as safe as separate surgeries, could shorten the length of hospital stay and might lead to fewer surgery-related complications," said Srinevas Reddy, M.D., a surgical resident at Duke.
But for patients needing major hepatic resection, both mortality and severe morbidity were significantly higher after simultaneous versus staged procedures, reported Dr. Reddy and colleagues at the Society of Surgical Oncology meeting here on the basis of a 20-year retrospective study.
Chemotherapy after hepatectomy, but not before, was also associated with longer survival, found the researchers at Duke and colleagues at the Johns Hopkins in Baltimore, and the University of Texas M.D. Anderson Cancer Center in Houston.
The retrospective study compared post-operative and long-term outcomes after simultaneous and staged colorectal and hepatic resections. They reviewed clinicopathologic data, surgical and medical treatments, and post-operative courses from 1985 through 2006 at the three centers, and long-term outcomes.
In all, 135 patients had simultaneous surgical resection of colorectal cancer and synchronous liver metastases, and 475 underwent staged procedures.
The patients who had the simultaneous procedures had fewer metastases (median of one, versus two for patients who underwent staged procedures), smaller median metastatic lesion (2.5 cm in diameter versus 3.5 cm), and were significantly less likely to have undergone pre-hepatectomy chemotherapy or have major hepatectomies, defined as resection of three or more segments (odds ratio 0.2, P
In nultivariate analyses, independent predictors for worse survival included concurrent radiofrequency ablation of liver metastases (odds ratio 1.6) and CEA > 200 ng/mL (odds ratio 2.1). In contrast, chemotherapy after hepatectomy was associated with longer survival (odds ratio 0.6).
"This study is important because it shows that patients with liver metastases at the time of their original colorectal cancer diagnosis might benefit from evaluation at a multidisciplinary center that includes not only medical oncologists and surgical oncologists skilled in colorectal surgery, but also surgeons capable of performing liver surgery," said senior author Bryan Clary, M.D., a surgical oncologist at Duke.
Limitations of the study include the retrospective design, changes in the definition of "resectable" hepatic disease over time because of improvements in operative techniques and critical care, and lack of information about the number of patients for whom staged resection was planned but not completed because of progression of hepatic disease. Differences in drug regimens and chemotherapy administration also precluded evaluation of the relative efficacy of specific regimens.