Is laparoscopic simultaneous resection for colorectal cancer and synchronous liver metastases safe and useful?

Abstract Background Of the few studies comparing simultaneous versus staged resection of primary colorectal cancer and synchronous liver metastases, most are limited to resections performed at the same facility. This study was performed to compare outcomes of simultaneous versus staged resection in these patients, including resections performed at a different center. Methods The Nationwide Readmissions Database was queried for all patients undergoing colorectal cancer and metastatic liver resections in the US from 2010 to 2014. Patients undergoing simultaneous resections were compared to patients who underwent liver and colon resections on separate admissions, both liver first and colon first. The outcomes of interest were in-hospital mortality, complications, and total cost. Results During the study period, there were 6,219 patients undergoing resection of primary colorectal cancer and synchronous liver metastases. Separate admission resection was performed at a different hospital in 45.8%. Compared to simultaneous resection, there was a reduced risk for mortality in patients undergoing colon first (OR 0.28, p<0.01) and there was no significant difference in performing liver resection first (OR 0.30, p=0.05). Simultaneous resection was associated with a decreased mean total cost of admissions compared to separate admission resection ($37,278 ±$34,353 versus $47,985 ±$ 28,342, p<0.01). Conclusions Nearly half of separate admission resections of primary colorectal cancer and liver metastases are performed at different hospitals and likely missed by single-center studies. Undergoing colon resection first on a separate admission is costlier, yet patients have more favorable outcomes. Further studies are needed to reveal the underlying factors responsible for these improved outcomes.

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Is simultaneous resection of colorectal cancer and synchronous liver metastases safe in the elderly?: a single-center, retrospective cohort study

HPB ◽

10.1016/j.hpb.2018.06.2607 ◽

2018 ◽

Vol 20 ◽

pp. S361

Author(s):

S.W. Park ◽

S.J. Park ◽

S.H. Kim ◽

J.H. Oh

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Liver Metastases ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

The Elderly ◽

Single Center ◽

Synchronous Liver Metastases ◽

Simultaneous Resection

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Simultaneous resection of colorectal cancer with synchronous liver metastases: A survey-based analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15073 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15073-e15073

Author(s):

Pablo Emilio Serrano Aybar ◽

Christopher Griffiths ◽

Jessica Bogach ◽

Leyo Ruo ◽

Julie Hallet ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Response Rate ◽

Rectal Resection ◽

Low Complexity ◽

Categorical Variables ◽

Synchronous Liver Metastases ◽

Simultaneous Resection ◽

Clinical Scenarios ◽

General Surgeons

e15073 Background: Patients with colorectal cancer and synchronous liver metastases may undergo simultaneous or staged resection. Methods: We electronically surveyed members of the Society of Surgical Oncology, Canadian Hepato-Pancreato-Biliary Association and the College of Physicians and Surgeons of Ontario with a pilot-tested questionnaire. Four clinical scenarios were presented. Perceived outcomes of and barriers to simultaneous resection were assessed on a Likert scale using Mann-Whitney U and Chi-square tests for ordinal and categorical variables, respectively. We compared results between general and hepatobiliary surgeons. We sought to determine surgeons’ attitudes and perceived barriers to simultaneous resection and compare them between general and hepatobiliary surgeons. Results: The response rate of 20% (234/1166) included 50 general and 134 hepatobiliary surgeons. A high likelihood score (Likert ≥5-7) for support of simultaneous resection among general and hepatobiliary surgeons, respectively, included the following: for minor liver and low complexity colon, 83% and 98% (p < 0.001); for minor liver and rectal resection, 57% and 73% (p = 0.042); for complex liver and low complexity colon resection, 26% and 24% (p = 0.858); and, for complex liver and rectal resection, 11% and 7.0% (p = 0.436). Among hepatobiliary surgeons, the most common barriers for simultaneous resections were patient comorbidities and extrahepatic disease, whereas general surgeons additionally identified transferring care to another facility. Lack of information regarding non-responders is relevant given our relatively low response rate. Our respondents mostly worked in academic settings, which may not be representative of the majority of surgeons who manage colorectal cancer. Conclusions: Surgeon support for simultaneous resection increased with less complex surgery and was similar among hepatobiliary and general surgeons. Surgeons’ perceived practice patterns and barriers to simultaneous resection should inform clinical trials and disease care pathways.

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