Simultaneous versus staged resection of rectal cancer and synchronous liver metastases (RESECT)

A systematic review and meta-analysis
  • Andrew E. Giles
  • Marlie Valencia
  • Sameer Parpia
  • Erin Fu
  • Leyo Ruo
  • Marko Simunovic
  • Pablo E. SerranoEmail author



Staged resection is preferred to treat synchronous rectal cancer with liver metastases. Simultaneous resection of rectal cancer with synchronous liver metastases may potentially decrease postoperative complications, thereby improving quality of life, decreasing health care costs, and avoiding delays in postoperative chemotherapy administration. We evaluated the safety of simultaneous resection.


We searched Medline, Embase, and PubMed for studies comparing simultaneous versus staged resection. Study selection, data abstraction, risk of bias (ROB), and quality of the evidence (QOE) assessment were performed in duplicate. The primary outcome was overall postoperative complications. The secondary outcome was postoperative complications in the intervention group. ROB and QOE were assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).


4456 abstracts were retrieved; 18 retrospective cohort studies reported postoperative complications in the intervention arm, with six comparing intervention (288 patients) to control (287 patients). The odds ratio (OR) for overall complications was 0.93, 95% confidence interval (CI): 0.64–1.35, and for major complications was 0.77, 95%CI: 0.40–1.50. Proportion of complications (intervention arm): 41%, 95%CI: 33–50%. ROB was moderate.


Simultaneous resection of synchronous rectal cancer with liver metastases carries a similar risk of overall and major complications compared to the staged approach. However, QOE is very low and a simultaneous approach ought to be pursued only in selected patients until better evidence is available.


Rectal cancer Synchronous liver metastases Simultaneous resection Surgical strategies Postoperative complications 



Confidence interval


Grading of Recommendations, Assessment, Development, and Evaluations


National Surgical Quality Improvement Program


Odds ratio


Quality of the evidence


Risk of bias


Risk of Bias in Non-Randomized Studies of Interventions



Special thanks to Dr. Aristithes Doumouras and Ming Bi for their assistance in translating selected abstracts and full-text articles.


This research did not receive any funding from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

A.E. Giles, M. Valencia, S. Parpia, E. Fu, L. Ruo, M. Simunovic, and P.E. Serrano declare that they have no competing interests.

Supplementary material

10353_2019_582_MOESM1_ESM.docx (19 kb)
SUPPLEMENT 1: MEDLINE Search strategy
10353_2019_582_MOESM2_ESM.docx (18 kb)
SUPPLEMENT 2: EMBASE Search strategy
10353_2019_582_MOESM3_ESM.docx (37 kb)
SUPPLEMENT 3: Summary of studies including primary outcome (comparison of overall complications between surgical approaches)
10353_2019_582_MOESM4_ESM.tiff (131 kb)
SUPPLEMENT 4: Systematic review risk of bias summary. Empty cell indicates item not assessable
10353_2019_582_MOESM5_ESM.docx (21 kb)
SUPPLEMENT 5: GRADE Summary of findings for comparisons of primary (overall complications) and secondary (major complications) outcomes
10353_2019_582_MOESM6_ESM.docx (20 kb)
SUPPLEMENT 6: GRADE evidence profile for comparisons of primary (overall complications) and secondary (major complications) outcomes
10353_2019_582_MOESM7_ESM.tiff (58 kb)
SUPPLEMENT 7: Single-arm analysis of overall postoperative complication rate among simultaneous resections
10353_2019_582_MOESM8_ESM.tiff (38 kb)
SUPPLEMENT 8: Single-arm analysis of major postoperative complications among simultaneous resections


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Andrew E. Giles
    • 1
  • Marlie Valencia
    • 1
  • Sameer Parpia
    • 2
    • 3
  • Erin Fu
    • 1
  • Leyo Ruo
    • 1
  • Marko Simunovic
    • 1
    • 2
  • Pablo E. Serrano
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Department of Surgery, Hamilton Health SciencesMcMaster UniversityHamiltonCanada
  2. 2.Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
  3. 3.Ontario Clinical Oncology Group, Department of OncologyMcMaster UniversityHamiltonCanada
  4. 4.Juravinski Hospital & Cancer CentreHamiltonCanada

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