A “time-test” approach was advocated by some authors to evaluate the biological behavior of the neoplasm, to treat potentially occult disease, and to avoid operation in patients with rapidly progressing tumors.51 Furthermore, neoadjuvant chemotherapy can be administered before delayed hepatectomy for synchronous NVP-AUY922 ic50 liver metastases. However, no difference in survival was encountered between the two hepatectomy strategies either in the present analysis or other series,22,

26, 40 and no clear benefit from a time-test approach was defined. In the past decades, the strategy of the delayed hepatectomy approach gained popularity and has been established as the standard surgical practice. Some authors hold the view that simultaneous resections may increase the rate of postoperative complications, particularly the risk of insufficiency of the colorectal anastomosis by the additional burden of a simultaneous major hepatectomy.52, 53 However, the fact that delayed resections require two separate operations

and the negligible morbidity and mortality in modern hepatectomy demonstrated by the accumulating evidence have prompted some surgeons to attempt simultaneous resections of primary tumors and liver metastases. When the specific laparotomy complications were evaluated, it was increased in delayed group in Martin et al.’s study.41 Reddy et al. found that http://www.selleckchem.com/products/Everolimus(RAD001).html simultaneous resection strategy would increase the complications compared to liver surgery alone is not surprising, given the evidence from large series that simultaneous extrahepatic procedures increase morbidity after partial hepatectomy.27, 54 Other large studies38, 49, 55 have also shown that simultaneous resections were not associated with elevated hepatic or colon complications compared to delayed resections. This systematic review and meta-analysis also indicated that SCRLM patients who underwent only one procedure in selected conditions in which both safety and effectiveness

are enhanced by the simultaneous resection strategy is acceptable. It was expected that delayed hepatectomy would have a longer duration of procedure and hospital stay as well as more blood loss during operation. These findings were also confirmed MCE in the current analysis. Blood loss has been shown to have a deleterious impact on both short- and long-term outcomes of the operation and is considered one of the important selective factors of hepatectomy strategy for SCRLM. Furthermore, hepatectomy is associated with a median blood loss of 450 to 1,500 mL and perioperative transfusion for major blood loss is also associated with an adverse prognosis.56, 57 Thus, in patients who have already had a large volume of blood loss during colectomy, a delayed hepatectomy approach should be considered instead.