Abstract:

Objective

To investigate the safety and efficacy of simultaneous surgical resection for synchronous colorectal cancer liver metastasis （SCRLM）.

Methods

Clinical data of 100 patients with SCRLM who underwent radical surgery in Provincial Hospital Affiliated to Anhui Medical University， from August 2017 to February 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.According to different surgical timing，all patients were divided into the simultaneous surgery group （n=70） and staged surgery group （n=30）.Preoperative CEA and CA19-9 levels， primary tumor type， postoperative pathology， location， size and number of liver metastases， intraoperative blood loss， operation time， length of hospital stay， hospitalization expenses，postoperative complications and recurrence-free survival were compared between two groups.Perioperative indexes between two groups were compared by Mann-Whitney U test.The rates were compared by Chisquare test or Fisher’s exact probability test.Recurrence-free survival （RFS） was compared by Kaplan-Meier method and Log-rank test.Prognostic factors were analyzed by Cox proportional hazards regression model.

Results

No patient died within postoperative 30 d in two groups.In the simultaneous and staged surgery groups， the median operation time was 287（216，349） and 310（267， 399） min， intraoperative blood loss was 150（100， 200） and 100（50， 150） ml， the length of hospital stay was 18（15， 25） and 28（24， 32） d and hospitalization expense was 5.8×10⁴ （4.9×10⁴， 7.3×10⁴） and 8.6×10⁴ （7.9×10⁴， 9.6×10⁴） Yuan， respectively.The differences were statistically significant between two groups （Z=-2.03， 0.96， -4.94 and -0.86； all P＜0.05）.In the simultaneous surgery group， 21 patients received blood transfusion and 2 in the staged surgery group， and the difference was statistically significant （χ²=6.46， P＜0.05）.In the simultaneous and staged surgery groups， 50 and 22 patients experienced postoperative recurrence， and the median RFS was 6.0 and 8.5 months，with no statistical significance between two groups （χ²=0.46， P＞0.05）.Multivariate Cox regression analysis showed that stage T3-T4 primary tumor， multiple liver lesions， KRAS mutation， CA19-9＞100 kU/L and neoadjuvant chemotherapy were the independent risk factors for clinical prognosis （HR=10.88， 0.57， 3.66， 1.28，0.66； all P＜0.05）.

Conclusions

Simultaneous surgery can shorten the operation time and length of hospital stay， reduce hospitalization expenses for SCRLM patients.Although it increases the amount of intraoperative bleeding， it does not elevate the incidence of postoperative complications， and yields equivalent recurrence-free survival to staged surgery.Simultaneous surgery is safe and effective for patients with SCRLM.

Key words: Colorectal neoplasms, Synchronous liver metastases, Surgical procedures, operative