35–37 However, none of these prognostic factors have been considered as a contraindication to liver resection.38 Synchronous CLM did not influence the survival in the simultaneous resection group. The reported 5-year survival rate after liver resection for patients

with synchronous CLM range 20–40%.13,15,16 www.selleckchem.com/products/epacadostat-incb024360.html In addition, with the innovation of surgical techniques and the constant improvement of the comprehensive treatment, more and more recent studies demonstrated that the strategy to simultaneously resect the primary tumor and the synchronous metastases has a similar overall survival rate at 1, 3 and 5 years compared to staged liver resection.10,12,15,16,27 Traditionally, staged resection has been considered as the preferable choice in dealing with synchronous CLM. Several authors have stressed that simultaneous resection may increase the rate of postoperative complications and mortality.23,39,40 In particular, they feared increasing the risk of insufficiencies of the colorectal anastomosis, by the additional burden of a simultaneous liver resection.23 In this meta-analysis, we found that the overall postoperative morbidity after GPCR Compound Library simultaneous resection was lower than that after staged resection of SCLM. However, there was no significant

difference in mortality and blood loss between the two groups. These results

may be explained by the need for two laparotomies and a resulting increase of complications associated with laparotomy. On the other hand, recent advances in hepatobiliary surgical training, hepatobiliary techniques, anesthetic management MCE and overall critical care have made hepatic resection safer and increased overall quality of life.20 With the safety of simultaneous resection being shown in selected patients and the improvement of operative techniques, the operation indications for simultaneous resection of liver metastases from colorectal has been extended. This has made some original relative contraindications into resectable cases. Formerly, simultaneous resection has been performed for smaller and fewer liver metastases. Nowadays, for patients with synchronous CLM, a single operation will be preferred if it is safe and superior in a prognostic aspect. Jovine et al.41 also reported that simultaneous colonic and liver resection should be undertaken in selected patients with synchronous colorectal liver resection regardless of the extent of hepatectomy. In fact, major liver resection seems capable of providing better oncological results, allowing resection of liver micrometastases that are located in the same liver lobe of macroscopic lesions.