Outcomes of Simultaneous Major Liver Resection and Colorectal Surgery for Colorectal Liver Metastases

Background The optimal surgical strategy for treating colorectal cancer liver metastases (CRLM) in patients requiring major liver resection (MLR) is controversial, especially in rectal cancer patients. Method Between March 2004 and January 2015, 103 patients underwent MLR for CRLM and underwent MLR simultaneously with colorectal surgery (simultaneous group; n=55) or MLR after colorectal surgery (liver-only group; n=48). Results There were no significant differences in sex, age, ASA score, BMI, size and number of liver metastases, liver resection margin, surgical outcomes, and estimated blood loss. The rates of postoperative complications (simultaneous group vs. liver-only group; 76.4 % vs. 62.5 %; P=0.126) and major complications (29.0 % vs. 25.0 %; P=0.513) were also similar in both groups. The time to starting a soft diet was longer in the simultaneous group (6.0 days vs. 3.4 days; P<0.001), but the length of hospital stay was similar (14.9 days vs. 13.3 days; P=0.345). There were no perioperative deaths, anastomotic leakage, or septic complications. Among patients who underwent rectal surgery, the frequency of complications was greater in the simultaneous group (87.0 % vs. 56.2 %; P=0.031), but there was no difference in major complications (34.7 % vs. 25.0 %; P=0.822). The postoperative morbidity index was 0.204 and 0.180 in the simultaneous and liver-only groups, respectively, in all patients, and was 0.227 and 0.136, respectively, in the rectal surgery subgroup. Conclusion Simultaneous MLR is feasible and safe in synchronous CRLM patients, including rectal cancer patients.