Surgical treatment of synchronous hepatic metastases of colorectal cancer: Simultaneous resection or delayed resection?

The surgical strategy for resectable synchronous hepatic metastases of colorectal cancer remains controversial. The retrospective analysis of our series of resectable synchronous hepatic metastases focused on the percentage of simultaneous resections, the circumstances, the indications and the results of the one-step procedure compared to the two;step strategy. From January 1, 1982 to December 31, 1995, 129 patients were operated on for resection of hepatic metastases of colorectal cancer. Forty one patients (32 %) presented with synchronous hepatic metastases, 20 of whom (49 %) underwent simultaneous resection of the primary tumor and the hepatic metastases (simultaneous resection group : SR). For the other 21 patients (51 %), the hepatic resection was delayed for a mean interval of 5.2 +/- 4.2 months (delayed resection group: DR). The mean age of the 2 groupes was not significantly different (54 years versus 58 years). When the primary tumor was located on the ascending colon, the hepatic excision was performed simultaneously in 9 out often cases. The need for blood transfusion and the volume required were not significantly different between the two groups. The length of each surgical operation was comparable between the two groups (331 +/- 76 minutes SR vs 330 +/- 88 minutes DR). Postoperative complications were observed in 20 % of patients in the SR group and 10 % of patients in the DR group (no significative difference). There was no postoperative mortality in either group. Survival was 83 %, 44 % and 37 % at 1, 2 and 3 years respectively in the SR group and 79 %, 59 % and 49 % in the DR group, with no significant difference between the groups. These results show that simultaneous resection of the primary tumor and the hepatic metastases did not increase either morbidity or mortality in our study, and that it should be proposed especially to patients presenting with a primary tumor of the ascending colon with metastases resectable by means of a minor hepatectomy.