Benefits and risks of simultaneous versus staged laparoscopic resection for colorectal cancer with synchronous liver metastases.

[PURPOSE] To compare the advantages and disadvantages of simultaneous laparoscopic hepatocolorectal resection and staged resection for colorectal cancer with synchronous liver metastasis.

[METHODS] Patients with colorectal cancer and synchronous liver metastases who underwent laparoscopic surgery were divided into simultaneous (n = 38) and staged (n = 56) resection groups and their short-term outcomes and medical expenses were then retrospectively compared.

[RESULTS] The postoperative hospital stay was significantly shorter and the total medical costs were lower in the simultaneous group. However, the major complication rate (Clavien-Dindo classification ≥ 3a) was higher in the simultaneous group (28.9% vs. 12.5%, P = 0.047). After performing propensity score-adjusted logistic regression, simultaneous resection remained significantly associated with major complications (odds ratio, 5.11; P = 0.006). In a univariate analysis, the platelet count < 150,000/µL, liver metastasis diameter ≥ 3 cm, and difficulty score ≥ 6 were identified as potential risk factors for major complications in the simultaneous group. In a multivariate analysis, a difficulty score ≥ 6 was a significant risk factor (odds ratio, 9.63; P = 0.004).

[CONCLUSIONS] Simultaneous laparoscopic resection reduces the surgical burden and medical costs but carries a heightened perioperative risk. Staged resection should therefore be considered for patients with risk factors, particularly for those requiring hepatectomy with a difficulty score of ≥ 6.