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.