Strategies for the treatment of synchronous liver metastasis

Aim: Observe the outcomes after complete simultaneous or delayed resection of synchronous liver metastasis (SLM) from colorectal cancer (CRC). Methods: From 1994 to 2005, 119 patients were diagnosed with CRC and SLM; 57 patients had simultaneous resection (group I) and 62 patients had staged resection (group 11). Perioperative chemotherapy was considered completed if all expected cycle were administrated. Results: Overall survival rates of group I-group II at 1, 3 and 5 years were respectively 91%-93% (p = 0,3), 59%-57% (p = 0,09) and 32%-25% (p = 0,06). The median survival time of group I-group II were respectively 46 months-40 months (p = 0,07). There was no statistical difference on survival regarding location of metastasis (p = 0,09) or primary tumor location (p = 0,2). Patients with simultaneous or staged resection receiving optimal treatment (R0 liver surgery and complete chemotherapy) were respectively 89% and 67% (p = 0,04). Twenty three patients developed isolated liver recurrence with higher frequency in staged patients (26% vs 9% p = 0,03) without impairment of survival. Conclusions: Because of postoperative morbidity and prolonged tiring treatment, many patients having staged resection were under treated. However we did not observe statistical difference on survival but we supported that simultaneous resection has to be prefer to achieve an optimal treatment. Lung and bone metastasis are the new challenge for oncologists. (c) 2007 Elsevier Ltd. All rights reserved.