Combined colon and hepatic resection for synchronous colorectal liver metastases

Background and Objectives: The surgical strategy for the treatment of resec table synchronous hepatic metastases of colorectal cancer remains controver sial. This study was per-formed to assess the outcome of combined resection of colorectal cancer and liver metastases. Methods: The perioperative data, morbidity, and survival of the patients wh o underwent combined colon and liver resections for synchronous colorectal liver metastases from 1988 to 1999 were compared to the parameters of the p atients who underwent colon resection followed by resection of liver metast ases in a staged setting. Results: 198 hepatic resections were performed, of which 112 procedures in 103 patients were done for metastatic colorectal carcinoma. Twenty six pati ents (25%) had combined hepatic and colon resection and were compared to 86 patients with metachronous metastases who underwent colon and hepatic rese ction in the staging setting. Postoperative morbidity was 27 and 35%, respe ctively. There was no hospital mortality in the combined group vs. 2.3% in the staged group. Blood loss, intensive care unit (ICU) stay and length of postoperative stay (LOS) were similar in both groups. The 5 years cumulativ e survival of the group after combined surgery was 28% vs. 27% of the group after isolated hepatic resections (P = 0.2 1). Conclusion: Combined colon and hepatic resection is a safe and efficient pr ocedure for the treatment of synchronous colorectal liver metastases. It ca n be performed with acceptable morbidity and no perioperative mortality. Th e survival after combined procedure is comparable to the one achieved after staged procedure of colon resection followed by liver resection. (C) 2001 Wiley-Liss, Inc.