Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases

Background: The optimal surgical strategy for patients with synchronous colorectal liver metastases (CLMs) is still unclear. The aim of this study was to compare simultaneous colorectal and hepatic resection with a delayed strategy in patients who had a limited hepatectomy (fewer than three segments). Methods: All patients with synchronous CLMs who underwent limited hepatectomy between 1990 and 2006 were included retrospectively. Short-term outcome, overall and progression-free survival were compared in patients having simultaneous colorectal and hepatic resection and those treated by delayed hepatectomy. Results: Of 228 patients undergoing hepatectomy for synchronous CLMs, 55 (24·1 per cent) had a simultaneous colorectal resection and 173 (75·9 per cent) had delayed hepatectomy. The mortality rate following hepatectomy was similar in the two groups (0 versus 0·6 per cent respectively; P = 0·557), but cumulative morbidity was significantly lower in the simultaneous group (11 per cent versus 25·4 per cent in the delayed group; P = 0·015). Three-year overall and progression-free survival rates were 74 and 8 per cent respectively in the simultaneous group, compared with 70·3 and 26·1 per cent in the delayed group (overall survival: P = 0·871; progression-free survival: P = 0·005). Significantly more recurrences were observed in the simultaneous group at 3 years (85 versus 63·6 per cent; P = 0·002); a simultaneous strategy was an independent predictor of recurrence. Conclusion: Combining colorectal resection with a limited hepatectomy is safe in patients with synchronous CLMs and associated with less cumulative morbidity than a delayed procedure. However, the combined strategy has a negative impact on progression-free survival. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.