Synchronous resection of colorectal cancer and liver metastases: comparative views of colorectal and liver surgeons

• Published in: Colorectal disease Vol. 14; no. 8; pp. e477 - e485
• Main Authors: Qureshi, M. S., Goldsmith, P. J., Maslekar, S., Prasad, K. R., Botterill, I. D.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-08-2012
• Subjects: Attitude of Health Personnel; Colorectal cancer liver metastases; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; colorectal surgeons; Colorectal Surgery - methods; Hepatectomy - methods; Humans; Liver Neoplasms - secondary; Liver Neoplasms - surgery; liver surgeons; Practice Patterns, Physicians' - statistics & numerical data; Surveys and Questionnaires; synchronous metastases; synchronous resection; Treatment Outcome; two staged resection; United Kingdom
• DOI: 10.1111/j.1463-1318.2012.02992.x
• EISSN: 1463-1318
• ISSN: 1462-8910

Aim  The optimal management of patients presenting with colorectal cancer and synchronous liver metastases is controversial. This survey was intended to summarize the opinions of UK colorectal and liver surgeons on the specific issues pertaining to synchronous resection.
Method  A validated electronic survey was sent to the consultant members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the Association of Upper Gastrointestinal Surgeons (AUGIS). The questions were structured to allow direct comparison between the two groups of the responses obtained.
Results  Four hundred and twenty‐four specialist colorectal surgeons and 52 specialist hepatobiliary surgeons were identified from the register of their respective associations. Responses were obtained from 133 (31%) colorectal and 22 (42%) liver surgeons. A majority of both groups of surgeons felt that synchronous resection was a valid therapeutic option. A majority of both groups believed that synchronous resection was justified despite the options of laparoscopic surgery and enhanced recovery programmes for each discipline. Agreed possible advantages of synchronous resections were: a decrease in the overall length of hospital stay, cost and patient anxiety. The major concern about synchronous resections was an excessive overall physiological insult. Specific scenarios indicated that synchronous resection was favoured for major/complex major colorectal resection with minor liver resection or most colorectal resections not involving an anastomosis with either a minor or major liver resection.
Conclusion  Although significant concerns relating to synchronous resection remain amongst colorectal and liver surgeons, a majority of them felt that synchronous resections could be offered to appropriately selected patients.