Predictive Factors for Anastomotic Leakage after Simultaneous Resection of Synchronous Colorectal Liver Metastasis

BACKGROUND: The optimal surgical strategy for resectable, synchronous, colorectal liver metastases remains unclear. The objective of this study was to determine which patients could benefit from staged resections instead of simultaneous resection by identifying predictive factors for postoperative morbidity and anastomotic leakage after simultaneous resection of synchronous, colorectal liver metastases and the primary colorectal tumor. METHODS: This study involved 86 patients with synchronous colorectal liver metastases who underwent simultaneous resection of the primary colorectal tumor and the hepatic tumor. Postoperative mortality, morbidity, and other surgical outcomes, including survival and hospitalization, were assessed. Predictive factors for postoperative morbidity and for anastomotic leakage were evaluated. RESULTS: Postoperative morbidity and anastomotic leakage were found in 55 (64%) and 18 (21%) patients. Predictive factors for postoperative morbidity and for anastomotic leakage were intraoperative blood loss and operation time >8 h, respectively. The overall 5-year survival rate was 45%. CONCLUSIONS: The frequency of morbidity and that of anastomotic leakage seemed to be high after simultaneous resection for synchronous colorectal liver metastases, especially when intraoperative blood loss or operation time increased greatly. Staged resections should be considered in cases in which excessive surgical stress from simultaneous resection of synchronous colorectal liver metastases would be expected.