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Original Article
October 1, 2006

Selection Criteria for Simultaneous Resection in Patients With Synchronous Liver Metastasis

Author Affiliations

Author Affiliations: Divisions of Hepato-Biliary-Pancreatic Surgery and Artificial Organ and Transplantation, Department of Surgery, Graduate School of Medicine, University of Tokyo (Drs Minagawa, Kokudo, and Makuuchi), Department of Gastrointestinal Surgery, Cancer Institute Hospital (Dr Yamamoto), and Department of Surgery, National Cancer Center (Drs Sakamoto and Kosuge), Tokyo, Japan; and First Department of Surgery, Shinshu University, Matsumoto, Japan (Drs Miwa and Miyagawa).

Arch Surg. 2006;141(10):1006-1012. doi:10.1001/archsurg.141.10.1006

Hypothesis  While simultaneous resection has been shown to be safe and effective in patients with synchronous metastasis, neoadjuvant chemotherapy followed by hepatectomy has gradually gained acceptance for both initially nonresectable metastasis and resectable metastasis. The boundary between these treatments is becoming unclear. We hypothesized that factors associated with colorectal cancer may play an important role in the prognosis of patients with synchronous metastasis and may be useful for identifying patients who can be expected to have adequate results following simultaneous resection.

Design  Outcome study.

Setting  Tertiary referral center.

Patients  From January 1980 to December 2002, 187 patients underwent curative resection for synchronous liver metastasis from colorectal cancer. One hundred forty-two patients received simultaneous resection, 18 underwent staged resection, and 27 underwent delayed hepatic resection. Twenty-one clinicopathological factors were analyzed, and long-term prognosis was assessed.

Main Outcome Measures  Prognostic factors and patient survival.

Results  There was no in-hospital death. In a multivariate analysis, the factors that significantly affected the prognosis of synchronous metastasis were 4 or more lymph node metastases around the primary cancer (P<.001) and multiple liver metastases (P = .003). In patients with 3 or fewer lymph node metastases around the primary cancer, the 5-year survival rates of those with 1, 2 to 3, and 4 or more liver metastases were 63%, 33%, and 40%, respectively, but these rates were 15%, 22%, and 0%, respectively, in patients with 4 or more lymph node metastases around the primary cancer.

Conclusions  The results support the application of simultaneous resection in patients with 0 to 3 colorectal lymph node metastases. However, in patients with 4 or more colorectal lymph node metastases, biological selection by neoadjuvant chemotherapy may be more suitable.