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Simultaneous resection of synchronous colorectal liver metastasis: Feasibility and development of a prediction model
Ann Hepatobiliary Pancreat Surg
Published online September 28, 2022;  https://doi.org/10.14701/ahbps.22-043
Copyright © 2022 The Korean Association of Hepato-Biliary-Pancreatic Surgery.

Mufaddal Kazi1,2, Shraddha Patkar1,2, Prerak Patel1,2, Aditya Kunte1,2, Ashwin Desouza1,2, Avanish Saklani1,2, Mahesh Goel1,2

1Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India,
2Homi Bhabha National Institute, Mumbai, India
Correspondence to: Shraddha Patkar, MS, MCh
Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai 400012, India
Tel: +91-2224177000, E-mail: drshraddhapatkar@gmail.com
ORCID: https://orcid.org/0000-0001-8489-6825
Received June 15, 2022; Revised July 13, 2022; Accepted July 21, 2022.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Backgrounds/Aims: Timing of resection for synchronous colorectal liver metastasis (CRLM) has been debated for decades. The aim of the present study was to assess the feasibility of simultaneous resection of CRLM in terms of major complications and develop a prediction model for safe resections.
Methods: A retrospective single-center study of synchronous, resectable CRLM, operated between 2013 and 2021 was conducted. Upper limit of 95% confidence interval (CI) of major complications (≥ grade IIIA) was set at 40% as the safety threshold. Logistic regression was used to determine predictors of morbidity. Prediction model was internally validated by bootstrap estimates, Harrell’s C-index, and correlation of predicted and observed estimates.
Results: Ninety-two patients were operated. Of them, 41.3% had rectal cancers. Major hepatectomy (≥ 4 segments) was performed for 25 patients (27.2%). Major complications occurred in 20 patients (21.7%, 95% CI: 13.8%–31.5%). Predictors of complications were the presence of comorbidities and major hepatectomy (area under the ROC curve: 0.692). Unacceptable level of morbidity (≥ 40%) was encountered in patients with comorbidities who underwent major hepatectomy.
Conclusions: Simultaneous bowel and CRLM resection appear to be safe. However, caution should be exercised when combining major liver resections with bowel resection in patients with comorbid conditions.
Keywords : Colorectal liver metastasis; Synchronous; Simultaneous resection; Colorectal cancer