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Simultaneous resection of primary colorectal cancer and synchronous liver metastases is associated with a high cardiovascular complication rate

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Summary

Background

Optimal timing of liver surgery for synchronous metastases regarding a simultaneous or two-staged procedure is still controversially discussed. As randomized controlled trials are ethically disputable due to potential advantages of the simultaneous approach, the following matched pair analysis was performed to investigate feasibility and short-term outcome of the additional simultaneous hepatic approach compared to colorectal surgery alone.

Methods

A total of 74 patients undergoing simultaneous resection of primary colorectal cancer and synchronous liver metastases (CRC + LM) were individually case matched with patients receiving only colorectal surgery for Union for International Cancer Control (UICC) stage I-III cancer (CRC) according to: age, gender, American Society of Anesthesiologists (ASA) score, location, and T-stage of the primary tumor. Postoperative complications and risk factors for morbidity and mortality were analyzed retrospectively using univariate, multivariate, and binary logistic regression analyses.

Results

According to matching criteria both groups showed no differences regarding demographics and operative techniques for the primary colorectal tumor. In the CRC + LM group 4 major hepatectomies, 7 anatomic, 43 nonanatomic and 20 multiple nonanatomic resections were performed. Inhospital mortality (CRC vs. CRC + LM) was 2.7 versus 4.1 % and overall morbidity was 33.8 versus 35.1 %, respectively. Cardiovascular complications were significantly higher in the CRC + LM than in the CRC group (13.5 vs. 2.7 %). Multivariate analysis revealed that not simultaneous resection procedure but presence of chronic pulmonary disease was an independent risk factor.

Conclusions

Simultaneous resection procedures can be recommended in almost all patients without chronic pulmonary disease as well as chronic heart disease. Careful precautions, especially in patients with chronic pulmonary diseases, should be taken to avoid a high possibility of postoperative cardiovascular complications.

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References

  1. Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64:104–17.

    Article  PubMed  Google Scholar 

  2. Kusters M, Valentini V, Calvo FA, Krempien R, Nieuwenhuijzen GA, et al. Results of European pooled analysis of IORT-containing multimodality treatment for locally advanced rectal cancer: adjuvant chemotherapy prevents local recurrence rather than distant metastases. Ann Oncol. 2010;21:1279–84.

    Article  CAS  PubMed  Google Scholar 

  3. Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol. 2007;14:3481–91.

    Article  PubMed  Google Scholar 

  4. Martin RC II, Augenstein V, Reuter NP, Scoggins CR, McMasters KM. Simultaneous versus staged resection for synchronous colorectal cancer liver metastases. J Am Coll Surg. 2009;208:842–50. (discussion 850–842).

    Article  PubMed  Google Scholar 

  5. Bengtsson G, Carlsson G, Hafstrom L, Jonsson PE. Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg. 1981;141:586–9.

    Article  CAS  PubMed  Google Scholar 

  6. von Heesen M, Schuld J, Sperling J, Grunhage F, Lammert F, et al. Parenchyma-preserving hepatic resection for colorectal liver metastases. Langenbecks Arch Surg. 2012;397:383–95.

    Article  Google Scholar 

  7. Mansour J, Fong Y. Timing of the liver resection for patients with synchronous metastases: practical and outcome considerations. Ann Surg Oncol. 2007;14:2435–6.

    Article  PubMed  Google Scholar 

  8. Hopt UT, Drognitz O, Neeff H. Timing of resection in patients with colorectal carcinoma and synchronous liver metastases. Zentralbl Chir. 2009;134:425–9.

    Article  CAS  PubMed  Google Scholar 

  9. Yin Z, Liu C, Chen Y, Bai Y, Shang C, et al. Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): simultaneous or delayed? Hepatology. 2013;57:2346–57.

    Article  PubMed  Google Scholar 

  10. Martin R, Paty P, Fong Y, Grace A, Cohen A, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg. 2003;197:233–41. (discussion 241–232).

    Article  PubMed  Google Scholar 

  11. Reddy SK, Barbas AS, Clary BM. Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management? Ann Surg Oncol. 2009;16:2395–410.

    Article  PubMed  Google Scholar 

  12. Chen J, Li Q, Wang C, Zhu H, Shi Y, et al. Simultaneous vs. staged resection for synchronous colorectal liver metastases: a metaanalysis. Int J Colorectal Dis. 2011;26:191–9.

    Article  PubMed  Google Scholar 

  13. Capussotti L, Ferrero A, Vigano L, Ribero D, Lo Tesoriere R, et al. Major liver resections synchronous with colorectal surgery. Ann Surg Oncol. 2007;14:195–201.

    Article  PubMed  Google Scholar 

  14. Minagawa M, Yamamoto J, Miwa S, Sakamoto Y, Kokudo N, et al. Selection criteria for simultaneous resection in patients with synchronous liver metastasis. Arch Surg. 2006;141:1006–12. (discussion 1013).

    Article  PubMed  Google Scholar 

  15. Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg. 2003;90:956–62.

    Article  CAS  PubMed  Google Scholar 

  16. Tanaka K, Shimada H, Matsuo K, Nagano Y, Endo I, et al. Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery. 2004;136:650–9.

    Article  PubMed  Google Scholar 

  17. Thelen A, Jonas S, Benckert C, Spinelli A, Lopez-Hanninen E, et al. Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer. Int J Colorectal Dis. 2007;22:1269–76.

    Article  PubMed  Google Scholar 

  18. Hillingso JG, Wille-Jorgensen P. Staged or simultaneous resection of synchronous liver metastases from colorectal cancer—a systematic review. Colorectal Dis. 2009;11:3–10.

    Article  CAS  PubMed  Google Scholar 

  19. Pathak S, Sarno G, Nunes QM, Poston GJ. Synchronous resection for colorectal liver metastases: the future. Eur J Surg Oncol. 2010;36:1044–6.

    Article  CAS  PubMed  Google Scholar 

  20. Mentha G, Majno P, Terraz S, Rubbia-Brandt L, Gervaz P, et al. Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour. Eur J Surg Oncol. 2007;33(Suppl 2):S76–83.

    Article  PubMed  Google Scholar 

  21. Abbott AM, Parsons HM, Tuttle TM, Jensen EH. Short-term outcomes after combined colon and liver resection for synchronous colon cancer liver metastases: a population study. Ann Surg Oncol. 2013;20:139–47.

    Article  PubMed  Google Scholar 

  22. Luo Y, Wang L, Chen C, Chen D, Huang M, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastases. J Gastrointest Surg. 2010;14:1974–80.

    Article  PubMed  Google Scholar 

  23. Kaibori M, Iwamoto S, Ishizaki M, Matsui K, Saito T, et al. Timing of resection for synchronous liver metastases from colorectal cancer. Dig Dis Sci. 2010;55:3262–70.

    Article  PubMed  Google Scholar 

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Correspondence to O. Kollmar MD.

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Schuld, J., von Heesen, M., Jung, B. et al. Simultaneous resection of primary colorectal cancer and synchronous liver metastases is associated with a high cardiovascular complication rate. Eur Surg 48, 221–227 (2016). https://doi.org/10.1007/s10353-015-0382-0

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  • DOI: https://doi.org/10.1007/s10353-015-0382-0

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