Simultaneous hepatic resection benefits patients with synchronous colorectal cancer liver metastases

Objective： The safety of the simultaneous resection of synchronous colorectal cancer liver metastases （SCRLM） is still being debated. However, this simultaneous operative approach is more commonly adopted at present than in the past. Therefore, we compared simultaneous hepatic resection with delayed hepatic resection in this study.Methods： All patients with SCRLM diagnosed before initial treatment between January 2009 and September 2013 were retrospectively included in our study. Short-term and long-term outcomes were compared in patients who underwent simultaneous colorectal and hepatic resection and those treated by delayed hepatectomy.Results： Among the 73 patients diagnosed with SCRLM, simultaneous coloreetal and hepatic resection was performed in 60 patients （82.2%）, while delayed hepatic resection was performed in 13 patients （17.8%）. The mortality rate was zero. The postoperative complication rate after delayed resection was higher than, but not significantly different from, that after simultaneous resection （46% vs. 23%, P=0.166）. The duration of operating time （240 vs. 420 min, P〈0.05） and postoperative hospital stay time （11 vs. 18 days, P〈0.05） were shorter in the simultaneous resection group. After the initial treatments were given, the 1-, 2-, and 3-year survival rates in the simultaneous resection group were 77%, 59%, and 53%, respectively, whereas those in the delayed resection group were 67%, 42%, and 10%, respectively. The 5-year survival rate in the simultaneous resection group was 23%; overall survival differed significantly between the two groups （P=0.037）. Median disease-free survival （DFS） times were 19.1 months in the simultaneous resection group and 8.8 months in the delayed resection group. DFS differed significantly between the two groups. Coenclusions： Simultaneous colorectal and hepatic resection is safe and exhibits advantages in the longtime survival of patients.

Prognostic Analysis of 102 Patients with Synchronous Colorectal Cancer and Liver Metastases Treated with Simultaneous Resection

Background： The liver is the most common site for colorectal cancer （CRC） metastases. Their removal is a critical and challenging aspect of CRC treatment. We investigated the prognosis and risk factors of patients with CRC and liver metastases （CRCLM） who underwent simultaneous resections for both lesions. Methods： From January 2009 to August 2016, 102 patients with CRCLM received simultaneous resections of CRCLM at our hospital. We retrospectively analyzed their clinical data and analyzed their outcomes. Overall survival （OS） and disease-free survival （DFS） were examined by Kaplan-Meier and log-rank methods. Results： Median follow-up time was 22.7 months： no perioperative death or serious complications were observed. Median OS was 55.5 months： postoperative OS rates were l-year： 93.8%, 3-year： 60.7%, and 5-year： 46.4%. Median DFS was 9.0 months; postoperative DFS rates were l-year： 43.1%, 3-year： 23.0%, and 5-year 21.1%. Independent risk factors found in multivariate analysis included carcinoembryonic antigen 〉100 ng/ml, no adjuvant chemotherapy, tumor thrombus in liver metastases, and bilobar liver metastases for OS; age 〉60 years, no adjuvant chenlotherapy, multiple metastases, and largest diameter ≥3 cm for DFS. Conclusions： Simultaneous surgical resection is a safe and effective treatment for patients with synchronous CRC LM. The main prognostic factors are pathological characteristics of liver metastases and whether standard adjuvant chemotherapy is performed.

Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases:Between conventional and mini-invasive approaches

The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under debate.Staged approach,with initial colorectal resection followed by liver resection(LR),or even the reverse,liver-first approach in specific situations,is traditionally preferred.Simultaneous resections,however,represent an appealing strategy,because may have perioperative risks comparable to staged resections in appropriately selected patients,while avoiding a second surgical procedure.In patients with larger or multiple synchronous presentation of colorectal cancer and liver metastases,simultaneous major hepatectomies may determine worse perioperative outcomes,so that parenchymal-sparing LR should represent the most appropriate option whenever feasible.Mini-invasive colorectal surgery has experienced rapid spread in the last decades,while laparoscopic LR has progressed much slower,and is usually reserved for limited tumours in favourable locations.Moreover,mini-invasive parenchymal-sparing LR is more complex,especially for larger or multiple tumours in difficult locations.It remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or if we need further technological advances and surgical expertise,at least for more complex procedures.This review aims to critically analyze the current status and future perspectives of simultaneous resections,and the present role of the available miniinvasive techniques.

SIMULTANEOUS RESECTION OF A STAGE-Ⅲ PRIMARY SQUAMOUS CARCINOMA OF LUNG AND A CARCINOID OF CARDIA A CASE REPORT

Multiplc primary carcinona (MPC),disease with two or more ncoplasms,occurs in a patient simultancously of consecutively It is reported that

Synchronous left atrial myxoma and adenosquamous lung carcinoma

Atrial myxomas account for 40%-50% of primary cardiac tumors and as such are the most common primary heart tumors. Because prolapsing myxomas cause the intermittent obstruction of the valvular outflow tract during diastole, the signs and symptoms of left atrial myxoma resemble mitral stenosis. Myxoma may lead to systemic thromboembolic events from tumor fragmentation. In addition, lung carcinoma is a common tumor with highly heterogeneous malignancies.