Concurrent vs. staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases

PURPOSE: Resection of hepatic metastases is the preferred treatment for selected patients after resection of primary colorectal carcinoma, but timing is controversial. This study was designed to compare outcomes of patients receiving concurrent resection of hepatic metastases and the primary colorectal tumor with those of patients receiving staged resection (within 6 months). METHODS: We retrospectively analyzed medical records (1986-1999) of 96 consecutive patients with synchronously recognized primary carcinoma and hepatic metastases who underwent concurrent (64 patients) or staged (32 patients) colonic and hepatic resections performed at our institution. RESULTS: Concurrent and staged groups were similar in demographics, tumor grade, stage, preoperative comorbidity (cardiac and respiratory), characteristics of hepatic metastases, and single vs. multiple lesions. No significant differences were observed between groups (concurrent vs. staged) in type of colon resection (P = 0.45) or hepatic resection (P = 0.09), overall operative duration (mean, 430 vs. 427 minutes; P = 0.39), blood loss (mean, 890 vs. 889 ml; P = 0.87), volume of blood products transfused (mean, 326 vs. 185 ml; P = 0.08), perioperative morbidity (53 vs. 41 percent; P = 0.25), disease-free survival from date of hepatectomy (median, 13 vs. 13 months; P = 0.53), or overall survival from date of hepatectomy (median, 27 vs. 34 months; P = 0.52). There was no operative mortality. Overall duration of hospitalization was significantly shorter for concurrent than for staged resection (mean, 11 vs. 22 days; P : less than or equal to 0.001). CONCLUSIONS: Concurrent colectomy and hepatectomy is safe and more efficient than staged resection and should be the procedure of choice for selected patients in medical centers with appropriate capacity and experience.