Colorectal Cancer with Synchronous Liver Metastases: Influence of Surgical Strategy on Treatment Results and Costs
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Keywords

colorectal cancer
synchronous liver metastases
simultaneous and staged resections
treatment costs

Abstract

The objective of the research was to improve immediate and long-term results of treatment in patients with synchronous metastatic colorectal cancers (smCRC) developing surgical treatment program with application of simultaneous and staged methods for resection of primary tumor and liver metastases.   Materials and methods. The study was based upon reviewing treatment results for 125 patients with smCRC (рТ1-4N0-2M1 in colon cancer and рТ1-3N0-2M1 in rectal cancer) who underwent either simultaneous or staged surgical treatment in the period from 2008 till 2015 in the Division of Tumors of Abdominal Cavity and Retroperitoneal Space Organs of the National Cancer Institute.Results. A statistically significant difference was found among studied groups in terms of in-patient rehabilitation period. The total number of bed-days was 18.0 ± 9.5 and 31.0 ± 78 for the groups I and II, respectively, р < 0.001. Also, the advantage of simultaneous surgical tactics in the length of surgery was found that comprised 367.0 ± 71.8 min in the simultaneous resection group and 515.0 ± 119.1 min in the group of staged surgical interventions, р < 0.001. The most common complications included acute liver failure – (7 (11.3 %) and 3 (6.3 %) cases, р = 0.36) and peritoneal and pelvic abscesses – (5 (8.1 %) and 6 (12.5 %) cases, р = 044) in the groups I and II, respectively.  Surgical strategy with application of simultaneous resections led to higher rate of post-operative lethality –3 (4.8 %) cases, compared to staged operations –1 (2.1 %) case, although this difference was not statistically significant (р = 0.4). The 5-year cumulative survival rate among patients with smCRC who underwent R0-resection of primary tumor and synchronous liver metastases was 42 % and 35 % in the groups I and II, respectively, p=0.73. The average cost of treatment for one patient with smCRC in the group of staged surgical interventions exceeded that in the simultaneous resection group by 40.9% (р < 0.001).Conclusions. Liver resection in smCRC remains the only method that allows to improve the overall 5-year survival rate of patients independently of surgical tactics  by 42 % and 35 % in simultaneous and staged resections, respectively, p=0.73. Simultaneous resections of ≤ 3 segments of the liver with metastases and colon with primary tumor in smCRC is a safety surgical tactics – complications of ≥ ІІІа degree constitute 4.8 %. Simultaneous resections of > 3 segments of the liver with metastases and rectum with primary tumor in smCRC lead to a statistically significant increase in complications of ≥ ІІІа degree by 20.9 %, р = 0.007. The average cost of treatment for one patient with smCRC in the group of staged surgical interventions exceeded that in the simultaneous resection group by 40.9% (р < 0.001).
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