Abstracts
2000 Digestive Disease Week

# 2234 Is Combined Colectomy and Hepatectomy for Synchrounous Metastatic Colorectal Cancer More Efficient than Staged?
Heidi K. Chua, Bruce G. Wolff, David M. Nagorney, Gregory G. Tsiotos, Manuel Munoz - juarez, Dirk R. Larson, Karl Sondenaa, Kansas City, MO, Mexico City, Mexico, Rochester, MN

Background: Resection of hepatic metastases is the preferred treatment for selected patients after resection of primary colorectal cancer, but the optimal timing between colectomy and hepatectomy for synchronous metastases is controversial. Aim - Methods: To compare the outcome of concomitant resection of hepatic metastases with the colorectal primary, we analyzed 96 consecutive patients (1986-1998) undergoing either combined (CR - 64 patients) or staged (within 6 months) colonic and liver resections (SR - 32 patients) in patients in whom hepatic metastases were recognized synchronously with the primary cancer. Primary and metastatic cancer characteristics, perioperative details and long-term outcome were compared. Results: CR and SR groups were similar in demographics, primary grade cancer, stage and preoperative co-morbidities (cardiac and respiratory). Types of colon resection (p=0.45) and hepatic resection (p=0.106) did not differ between groups. The characteristics of the hepatic metastases, number, size, and lobar distribution were similar between the two groups. Overall operative duration (CR- 430 minutes, SR - 427 minutes, p=0.39) and blood loss (CR - 890 ml., SR - 889 ml., p=0.87) were also similar. The CR group received more blood transfusion but the data did not reach statistical significance (CR 326 ml., SR 185ml., p=0.08). There was no operative mortality. Perioperative morbidity was similar (CR - 53% vs SR - 41%, p= 0.25). Length of stay in the hospital was significantly less for CR patients (mean 11 days) than for SR patients (mean 22 days). [p=<0.001] Median disease free survival from colectomy was 13 months for the CR group and 17 months for the SR group (p=0.18). Disease free survival from date of hepatectomy was 13 months (median) for the CR group and 13 months for the SR group (p=0.53). Overall median survival from colectomy was 27 months for the CR group and 36 months for the SR group (p=0.29). Overall median survival from date of hepatectomy was 13 months for the combined group and 15 months for the staged group (p=0.66) Conclusion:Concomitant colectomy and hepatectomy is safe and more efficient than SR and should be undertaken in good risk with the availability of both colorectal and hepatic survival expertise.