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Simultaneous versus staged resection for synchronous colorectal liver metastases: The win ratio approach. American journal of surgery Endo, Y., Alaimo, L., Araujo Lima, H., Tsilimigras, D. I., Hyer, J. M., Guglielmi, A., Ruzzenente, A., Alexandrescu, S., Poultsides, G., Sasaki, K., Aucejo, F., Pawlik, T. M. 2022

Abstract

INTRODUCTION: In order to investigate the optimal approach for synchronous colorectal liver metastases (sCRLM), we sought to use the "win ratio" (WR), a novel statistical approach, to assess the relative benefit of simultaneous versus staged surgical treatment.METHODS: Patients who underwent hepatectomy for sCRLM between 2008 and 2020 were identified from a multi-institutional database. The WR approach was utilized to compare composite outcomes of patients undergoing simultaneous versus staged resection.RESULTS: Among 1116 patients, 642 (57.5%) presented with sCRLM; 290 (45.2%) underwent simultaneous resection, while 352 (54.8%) underwent staged resection. In assessing the composite outcome, staged resection yielded a WR of 1.59 (95%CI 1.47-1.71) over the simultaneous approach for sCRLM. The highest WR occurred among patients requiring major hepatectomy (WR=1.93, 95%CI 1.77-2.10) compared with patients who required minor liver resection (WR=1.55, 95%CI 1.44-1.70).CONCLUSIONS: Staged resection was superior to simultaneous resection for sCRLM based on a WR assessment.

View details for DOI 10.1016/j.amjsurg.2022.11.015

View details for PubMedID 36435656