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Simultaneous versus staged resection for synchronous colorectal liver metastases: The win ratio approach

Published:November 19, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.11.015

      Highlights

      • The optimal strategy of synchronous colorectal liver metastases (sCRLM) is unsolved.
      • The win ratio (WR) is used to analyze the hierarchical composite endpoints.
      • The WR is increasingly utilized for more “patients-centric” viewpoints.
      • Staged resection was superior to simultaneous resection for sCRLM based on the WR.
      • The WR was higher when major hepatectomy was needed.

      Abstract

      Introduction

      In order to investigate the optimal approach for synchronous colorectal liver metastases (sCRLM), we sought to use the “win ratio” (WR), a novel statistical approach, to assess the relative benefit of simultaneous versus staged surgical treatment.

      Methods

      Patients who underwent hepatectomy for sCRLM between 2008 and 2020 were identified from a multi-institutional database. The WR approach was utilized to compare composite outcomes of patients undergoing simultaneous versus staged resection.

      Results

      Among 1116 patients, 642 (57.5%) presented with sCRLM; 290 (45.2%) underwent simultaneous resection, while 352 (54.8%) underwent staged resection. In assessing the composite outcome, staged resection yielded a WR of 1.59 (95%CI 1.47–1.71) over the simultaneous approach for sCRLM. The highest WR occurred among patients requiring major hepatectomy (WR = 1.93, 95%CI 1.77–2.10) compared with patients who required minor liver resection (WR = 1.55, 95%CI 1.44–1.70).

      Conclusions

      Staged resection was superior to simultaneous resection for sCRLM based on a WR assessment.

      Keywords

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