Is it safe to do combined liver and colon surgery on all patients?

This study investigated whether certain patients should not be considered for combined liver and colon surgery.

For patients with colorectal cancer surgery remains the only option for cure. In up to 25% of patients with colorectal cancer the cancer will already have spread (metastasized) to the liver at diagnosis. For these patients there are two surgical options. Originally surgeons would do colon surgery first and at a later date do liver surgery while the patient is receiving chemotherapy. Recently, simultaneous liver and colon surgery have been carried out. Although this is reported to be feasible it is possible that it may not be safe for some patients.

The authors aimed to examine the safety of combimed colon and liver surgery for patients whose colorectal cancer has spread to the liver. 

The authors examined records of 3,088 patients who had undergone liver and colon surgeries. 53.1% had colon surgery only, 36% had liver surgery only and 10.9% had both liver and colon surgery (combined surgery).

Overall patients with combined surgery experienced a slower recovery. They were more likely to need more surgery within 30 days: 8.3% of patients compared to 4.9% for those who had colon surgery alone and 3.1% for those who had liver surgery alone. Patients who had combined surgery also had longer hospital stays: 8 days compared to 6 days (colon surgery alone) and 5 days (liver surgery alone).

Overall patients with combined surgery experienced a greater number of adverse events, mainly infections. They were twice as likely to suffer from infections in the surgical wounds or opening of the wound: 9.2% of patients compared to 4.7% (colon surgery alone) and 4.4% (liver surgery alone). They were twice as likely to suffer from blood infections (sepsis): 9% compared to 4.7% (colon surgery alone) and 4.4% (liver surgery alone). They were also more likely to have pneumonia (lung infection): 4.7% of patients compared to 2.3% (colon surgery alone) and 2.5% (liver surgery alone).

The authors concluded that it is possible to surgically remove part of the intestine and liver in one operation. However, patients receiving combined surgery are more likely to have a longer recovery time and are more likely to suffer from infections. They recommend that any patients at higher risk of infections or health problems should not undergo the double surgery.