Surgical treatment of colorectal liver metastasis: the impact of simultaneous liver and colorectal resection for synchronous colorectal metastasis

Background: Metastatic liver diseases are a challenging situation with dismal prognosis. Nearly half of the patients develop liver metastasis during the course of their diseases. Hepatic resection is the treatment of choice in these patients.

Aim: This study was conducted to compare the results of patients undergoing simultaneous liver and colorectal resection and of those by whom a colorectal and liver resection was made separately.

Material and Method: A retrospective analysis was performed on 1597 patients who underwent surgery because of colorectal cancer between 1999 and 2008. The results were separately evaluated of the 152 patients who had liver metastasis.

Results: The proportion of the liver metastasis was 9.51%. The metastases arose in 40.8% from the rectum and in 31.8% from the sigmoid colon. It proved to be inoperable by 109 of the 152 patients who had liver metastasis. Simultaneous liver resection was performed in 14 cases and two step resection in 29 cases. In case of synchronous operations only minor liver surgery was done. The mean size of the metastasis was 2.6cm in diameter in the 1. and 4.6cm in Group 2 (p<0.005). Only minor complications could be observed in Group 1. The hospitalization was 13.1 days in Group 1 and 11.7 days in Group 2. The mean survival time was 37.3 and 47.9 month (p<0.005).

Conclusion: Simultaneous liver resection seems to be a safe procedure on those patients who develop small metastases with a limited number. Several authors prefer simultaneous major liver surgery with excellent results, which are particularly controversional to our opinion. Its cause is probably the fact that the proportion of advanced colorectal tumors is high in our patients. This suggests the necessity of an earlier diagnosis, the stenting of the tumorous strictures in increasing number and likewise the increasing role of neoadjuvant chemotherapy. The optimal timing of the liver resection and the identification of patients who will have the greatest benefit in survival still remains obscure.