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Invited Critique
October 1, 2006

Selection Criteria for Simultaneous Resection in Patients With Synchronous Liver Metastasis—Invited Critique

Arch Surg. 2006;141(10):1013. doi:10.1001/archsurg.141.10.1013

Decisions regarding optimal management of colorectal cancer and synchronous hepatic metastases, a factor in 15% to 30% of patients at presentation, pose a challenge to surgeons. Historically, many expert liver surgeons have recommended that limited hepatic resection be considered as a simultaneous procedure with colorectal resection, but if major hepatic resection (hemihepatectomy or greater) is required, the liver procedure should be performed in a staged or delayed fashion. However, simultaneous hepatic and colorectal resection is convenient for the patient and allows for earlier complete tumor clearance. The concern against the combined approach has been the potential exposure of such patients to excessive operative risk. The article by Minagawa and colleagues suggests that simultaneous colorectal and hepatic resection may be undertaken in most cases, even when major hepatectomy is required. In this study, 369 patients underwent curative hepatic resection and Minagawa and colleagues report an impressive 0% perioperative mortality. In 142 patients, hepatectomy was performed as a simultaneous procedure with colorectal resection. It is important to note that only 11% of the patients undergoing simultaneous procedures were subjected to hemihepatectomy or greater resection, compared with 39% and 37% of patients undergoing staged and delayed resections, respectively. In this regard, it is likely that Minagawa and colleagues exercised appropriate selection with plans for a delayed or staged resection in those requiring the most complex hepatic procedures or with significant medical comorbidity.