Ann Surg Treat Res.  2019 Oct;97(4):184-193. 10.4174/astr.2019.97.4.184.

Which strategy is better for resectable synchronous liver metastasis from colorectal cancer, simultaneous surgery, or staged surgery? Multicenter retrospective analysis

• Kye BH
• Lee SH
• Jeong WK
• Yu CS
• Park IJ
• Kim HR
• Kim J
• Lee IK
• Park KJ
• Choi HJ
• Kim HY
• Baek JH
• Lee YS

• KMID: 2459316
• DOI: http://doi.org/10.4174/astr.2019.97.4.184

Abstract

PURPOSE
The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends on various factors. The present study was intended to investigate the oncologic outcome according to the time of resection of metastatic lesions.
METHODS
Data from patients who underwent treatment with curative intent for primary CRC and synchronous LM between 2004 and 2009 from 9 university hospitals in Korea were collected retrospectively. One hundred forty-three patients underwent simultaneous resection for primary CRC and synchronous LM (simultaneous surgery group), and 65 patients were treated by 2-stage operation (staged surgery group).
RESULTS
The mean follow-up length was 41.2 ± 24.6 months. In the extent of resection for hepatic metastasis, major hepatectomy was more frequently performed in staged surgery group (33.8% vs. 8.4%, P < 0.001). The rate of severe complications of Clavien-Dindo classification grade III or more was not significantly different between the 2 groups. The 3-year overall survival (OS) rate was 85.0% in staged surgery group and 69.4% in simultaneous surgery group (P = 0.013), and the 3-year recurrence-free survival (RFS) rate was 46.4% in staged surgery group and 30.2% in simultaneous surgery group (P = 0.143). In subgroup analysis based on the location of primary CRC, the benefit of staged surgery for OS and RFS was clearly shown in rectal cancer (P = 0.021 and P = 0.015).
CONCLUSION
Based on our results, staged surgery with or without neoadjuvant chemotherapy should be considered for resectable synchronous LM from CRC, especially in rectal cancer, as a safe and fairly promising option.

Keyword

Colorectal neoplasms; Neoplasm metastasis; Surgical oncology

MeSH Terms

Classification
Colorectal Neoplasms*
Drug Therapy
Follow-Up Studies
Hepatectomy
Hospitals, University
Humans
Korea
Liver*
Neoplasm Metastasis*
Rectal Neoplasms
Retrospective Studies*

Figure

• 

  Fig. 1 A study flow diagram of this study.

• 

  Fig. 2 (A) The 3-year overall survival (OS) rate was 85.0% in the staged surgery group and 69.4% in simultaneous surgery group (P = 0.013); and (B) the 3-year recurrence-free survival rate was 46.4% in the staged surgery group and 30.2% in simultaneous surgery group (P = 0.143). The OS in staged surgery group is significantly better than in simultaneous surgery group.

• 

  Fig. 3 This figure shows the result of overall survival (OS) and recurrence-free survival (RFS) based on the location of primary CRC. (A) The OS in colon cancer patients was not significantly different between the staged surgery group and simultaneous surgery group (5-year OS rate: 76.6% vs. 55.6%, P = 0.295). However, (B) the OS in rectal cancer patients was significantly better in the staged surgery group than in simultaneous surgery group (5-year OS rate: 73.6% vs. 43.2%, P = 0.021). In the aspect of RFS, the results were almost the same with those for OS. (C) In colon cancer patients, RFS was not significantly different between the 2 groups. However, (D) rectal cancer patients in staged surgery group had better outcome of RFS (5-year RFS rate: 35.3% vs. 20.1%, P = 0.015).

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