2021年 · 第101卷第18期

synchronous liver metastases (SLM) of colorectal cancer refer to liver metastases found before or at the time of diagnosis of colorectal cancer. Initially resectable means that liver metastases can be completely resected in one operation without preoperative chemotherapy, portal embolization, or intraoperative vascular or biliary resection and reconstruction. At present, the question of whether initially resectable liver metastases of bowel cancer should be resected simultaneously with the primary bowel cancer or delayed resection remains controversial. To answer this question, a total of 105 patients with initially resectable bowel cancer with simultaneous liver metastases were enrolled in this prospective, multicenter, randomized controlled study and randomly assigned to contemporaneous resection of metastases and delayed resection. Eighty-five patients (39 in the contemporaneous resection group and 46 in the delayed resection group) were finally analyzed, with the primary outcome of concern being the incidence of major complications within 60 days after surgery, and the secondary outcome being overall patient survival (OS) and disease-free survival (DFS). Patients were followed up for 2 years after randomization. OS and DFS data were updated to 31 December 2017 for all patients. The results showed that there was no statistically significant difference in the incidence of major perioperative complications between the two groups (49% and 46% in the contemporaneous and delayed resection groups, respectively, adjusted forOR =0.84，95% CI：0.35~2.01，P =0.70）； The incidence of complications at the site of primary bowel cancer was 28% and 13% in the contemporaneous and delayed resection groups, respectively (P =0.08), and the incidence of complications at the site of liver metastases was 15% and 17%, respectively (P =0.80）。 In terms of patient prognosis, patients in the contemporaneous resection group tended to improve simultaneously in OS and DFS compared to the delayed resection group (P =0.05), and after a median follow-up of 47 months, there was a trend of sustained improvement in OS among patients in the contemporaneous resection group.