The John Goligher Colorectal Unit, Leeds General Infirmary, Leeds, UK.
Colorectal Dis. 2012 Aug;14(8):e477-85. doi: 10.1111/j.1463-1318.2012.02992.x.
The optimal management of patients presenting with colorectal cancer and synchronous liver metastases is controversial. This survey was intended to summarize the opinions of UK colorectal and liver surgeons on the specific issues pertaining to synchronous resection.
A validated electronic survey was sent to the consultant members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the Association of Upper Gastrointestinal Surgeons (AUGIS). The questions were structured to allow direct comparison between the two groups of the responses obtained.
Four hundred and twenty-four specialist colorectal surgeons and 52 specialist hepatobiliary surgeons were identified from the register of their respective associations. Responses were obtained from 133 (31%) colorectal and 22 (42%) liver surgeons. A majority of both groups of surgeons felt that synchronous resection was a valid therapeutic option. A majority of both groups believed that synchronous resection was justified despite the options of laparoscopic surgery and enhanced recovery programmes for each discipline. Agreed possible advantages of synchronous resections were: a decrease in the overall length of hospital stay, cost and patient anxiety. The major concern about synchronous resections was an excessive overall physiological insult. Specific scenarios indicated that synchronous resection was favoured for major/complex major colorectal resection with minor liver resection or most colorectal resections not involving an anastomosis with either a minor or major liver resection.
Although significant concerns relating to synchronous resection remain amongst colorectal and liver surgeons, a majority of them felt that synchronous resections could be offered to appropriately selected patients.
结直肠癌合并同步肝转移患者的最佳治疗策略仍存在争议。本研究旨在总结英国结直肠和肝脏外科医师对同步切除相关问题的意见。
对英国结直肠外科学会（ACPGBI）和英国上消化道外科学会（AUGIS）的顾问成员进行了一项经过验证的电子调查。问题的设计旨在允许对两组获得的答案进行直接比较。
从各自协会的登记册中确定了 424 名专业结直肠外科医师和 52 名专业肝胆外科医师。共有 133 名（31%）结直肠外科医师和 22 名（42%）肝脏外科医师做出了回应。大多数结直肠外科医师和肝脏外科医师均认为同步切除是一种有效的治疗选择。尽管腹腔镜手术和各学科的强化康复方案为治疗提供了选择，但大多数外科医师仍认为同步切除是合理的。两组外科医师均认为同步切除的可能优势在于：总体住院时间、成本和患者焦虑的减少。同步切除的主要关注点是过度的整体生理损伤。特定情况下，同步切除有利于主要/复杂的结直肠切除术伴较小的肝切除术，或大多数不涉及吻合术的结直肠切除术伴较小或较大的肝切除术。
尽管结直肠和肝脏外科医师对同步切除仍存在重大担忧，但大多数外科医师认为可以向适当选择的患者提供同步切除。
