BACKGROUND: The optimal surgical strategy for resectable synchronous colorectal liver metastases (SCLM), whether simultaneous or staged resections, still remains obscure. The aim of this study was to assess the efficacy of the predicted operation time (POT) strategy, which recommends staged resections in case of POT ≥6 h, otherwise selecting simultaneous resection. METHODS: This was a prospective, nonrandomized, single-institution study. Fifty-nine patients with SCLM underwent tumor resection according to the POT strategy, with patients with a longer POT (≥6 h) undergoing staged resection. Morbidity, overall hospitalization, tumor resection rates, and survival were compared with that of 86 patients who underwent simultaneous resection for SCLM irrespective of POT from 1992 to 2004. RESULTS: The former simultaneous and the latter POT strategy groups were similar in terms of patient and tumor demographics as well as surgical procedures. Of the 59 POT group patients, 26 patients (44 %) experienced 40 postoperative complications. Comparing the surgical results of simultaneous resection from 1992 to 2004 and those of resection according to the POT strategy, morbidity (64 vs. 44 %, p = 0.02), frequency of anastomotic leakage (21 vs. 5 %, p < 0.01), and length of hospital stay (27 vs. 18 days, p < 0.01) were significantly lower in the latter group, while tumor resection rates (85 vs. 87 %, p = 0.77) were not different. CONCLUSIONS: The POT strategy is effective in reducing the morbidity in SCLM patients by selecting staged resections in the high-morbidity-risk group without adverse effects on oncologic outcome.
BACKGROUND: The optimal surgical strategy for resectable synchronous colorectal liver metastases (SCLM), whether simultaneous or staged resections, still remains obscure. The aim of this study was to assess the efficacy of the predicted operation time (POT) strategy, which recommends staged resections in case of POT ≥6 h, otherwise selecting simultaneous resection. METHODS: This was a prospective, nonrandomized, single-institution study. Fifty-nine patients with SCLM underwent tumor resection according to the POT strategy, with patients with a longer POT (≥6 h) undergoing staged resection. Morbidity, overall hospitalization, tumor resection rates, and survival were compared with that of 86 patients who underwent simultaneous resection for SCLM irrespective of POT from 1992 to 2004. RESULTS: The former simultaneous and the latter POT strategy groups were similar in terms of patient and tumor demographics as well as surgical procedures. Of the 59 POT group patients, 26 patients (44 %) experienced 40 postoperative complications. Comparing the surgical results of simultaneous resection from 1992 to 2004 and those of resection according to the POT strategy, morbidity (64 vs. 44 %, p = 0.02), frequency of anastomotic leakage (21 vs. 5 %, p < 0.01), and length of hospital stay (27 vs. 18 days, p < 0.01) were significantly lower in the latter group, while tumor resection rates (85 vs. 87 %, p = 0.77) were not different. CONCLUSIONS: The POT strategy is effective in reducing the morbidity in SCLM patients by selecting staged resections in the high-morbidity-risk group without adverse effects on oncologic outcome.
Authors: R J de Haas; R Adam; D A Wicherts; D Azoulay; H Bismuth; E Vibert; C Salloum; F Perdigao; A Benkabbou; D Castaing Journal: Br J Surg Date: 2010-08 Impact factor: 6.939
Authors: Heidi K Chua; Karl Sondenaa; Gregory G Tsiotos; Dirk R Larson; Bruce G Wolff; David M Nagorney Journal: Dis Colon Rectum Date: 2004-08 Impact factor: 4.585
Authors: Srinevas K Reddy; Timothy M Pawlik; Daria Zorzi; Ana L Gleisner; Dario Ribero; Lia Assumpcao; Andrew S Barbas; Eddie K Abdalla; Michael A Choti; Jean-Nicolas Vauthey; Kirk A Ludwig; Christopher R Mantyh; Michael A Morse; Bryan M Clary Journal: Ann Surg Oncol Date: 2007-09-01 Impact factor: 5.344
Authors: Robert Martin; Philip Paty; Yuman Fong; Andrew Grace; Alfred Cohen; Ronald DeMatteo; William Jarnagin; Leslie Blumgart Journal: J Am Coll Surg Date: 2003-08 Impact factor: 6.113