We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Critique |

Selection Criteria for Simultaneous Resection in Patients With Synchronous Liver Metastasis—Invited Critique

William C. Chapman, MD
Arch Surg. 2006;141(10):1013. doi:10.1001/archsurg.141.10.1013.
Text Size: A A A
Published online


Decisions regarding optimal management of colorectal cancer and synchronous hepatic metastases, a factor in 15% to 30% of patients at presentation, pose a challenge to surgeons. Historically, many expert liver surgeons have recommended that limited hepatic resection be considered as a simultaneous procedure with colorectal resection, but if major hepatic resection (hemihepatectomy or greater) is required, the liver procedure should be performed in a staged or delayed fashion. However, simultaneous hepatic and colorectal resection is convenient for the patient and allows for earlier complete tumor clearance. The concern against the combined approach has been the potential exposure of such patients to excessive operative risk. The article by Minagawa and colleagues suggests that simultaneous colorectal and hepatic resection may be undertaken in most cases, even when major hepatectomy is required. In this study, 369 patients underwent curative hepatic resection and Minagawa and colleagues report an impressive 0% perioperative mortality. In 142 patients, hepatectomy was performed as a simultaneous procedure with colorectal resection. It is important to note that only 11% of the patients undergoing simultaneous procedures were subjected to hemihepatectomy or greater resection, compared with 39% and 37% of patients undergoing staged and delayed resections, respectively. In this regard, it is likely that Minagawa and colleagues exercised appropriate selection with plans for a delayed or staged resection in those requiring the most complex hepatic procedures or with significant medical comorbidity.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles