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Clin Colon Rectal Surg 2024; 37(02): 096-101
DOI: 10.1055/s-0043-1761475
Review Article

Combined Resection Approaches: Decision Making for Synchronous Resection, Timing of Staged Intervention to Optimize Outcome

Megumi Asai
1   Division of Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan
,
Kaitlyn D. Dobesh
1   Division of Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan
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Abstract

Advancement in systemic and regional radiation therapy, surgical technique, and anesthesia has provided a path for increased long-term survival and potential cure for more patients with stage IV rectal cancer in recent years. When patients have resectable disease, the sequence for surgical resection is classified in three strategies: classic, simultaneous, or combined, and reversed. The classic approach consists of rectal cancer resection followed by metastatic disease at a subsequent operation. Simultaneous resection addresses both rectal and metastatic disease in a single surgery. The reversed approach treats metastatic disease first, followed by the primary tumor in several months. Simultaneous resection is appropriate for selected patients to avoid delay of definitive surgery, and reduce number of surgeries, hospital stay, and cost to the health care system. It may also improve patients' psychological effect. Multidisciplinary discussions including colorectal and liver surgeons to review patients' baseline medical conditions, tumor biology and behavior, and disease burden and distribution is imperative to guide proper patient selection for simultaneous resection and perioperative treatments.

Keywords

combined resection - simultaneous resection - synchronous liver metastasis


Publication History

Article published online:
03 February 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Siebenhüner AR, Güller U, Warschkow R. Population-based SEER analysis of survival in colorectal cancer patients with or without resection of lung and liver metastases. BMC Cancer 2020; 20 (01) 246
    CrossrefPubMedGoogle Scholar
  • 2 van der Geest LG, Lam-Boer J, Koopman M, Verhoef C, Elferink MA, de Wilt JH. Nationwide trends in incidence, treatment and survival of colorectal cancer patients with synchronous metastases. Clin Exp Metastasis 2015; 32 (05) 457-465
    CrossrefPubMedGoogle Scholar
  • 3 Mitry E, Guiu B, Cosconea S, Jooste V, Faivre J, Bouvier AM. Epidemiology, management and prognosis of colorectal cancer with lung metastases: a 30-year population-based study. Gut 2010; 59 (10) 1383-1388
    CrossrefPubMedGoogle Scholar
  • 4 Brouwer NPM, van der Kruijssen DEW, Hugen N. et al. The impact of primary tumor location in synchronous metastatic colorectal cancer: differences in metastatic sites and survival. Ann Surg Oncol 2020; 27 (05) 1580-1588
    CrossrefPubMedGoogle Scholar
  • 5 Engstrand J, Nilsson H, Strömberg C, Jonas E, Freedman J. Colorectal cancer liver metastases - a population-based study on incidence, management and survival. BMC Cancer 2018; 18 (01) 78
    CrossrefPubMedGoogle Scholar
  • 6 Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 2006; 244 (02) 254-259
    CrossrefPubMedGoogle Scholar
  • 7 Suthananthan AE, Bhandari M, Platell C. Influence of primary site on metastatic distribution and survival in stage IV colorectal cancer. ANZ J Surg 2018; 88 (05) 445-449
    CrossrefPubMedGoogle Scholar
  • 8 Oweira H, Mehrabi A, Reissfelder C, Abdel-Rahman O. A real-world, population-based analysis of the outcomes of colorectal cancer patients with isolated synchronous liver or lung metastases treated with metastasectomy. World J Surg 2020; 44 (05) 1604-1611
    CrossrefPubMedGoogle Scholar
  • 9 Giuliante F, Viganò L, De Rose AM. et al. Liver-first approach for synchronous colorectal metastases: analysis of 7360 patients from the LiverMetSurvey Registry. Ann Surg Oncol 2021; 28 (13) 8198-8208
    CrossrefPubMedGoogle Scholar
  • 10 Conrad C, Vauthey JN, Masayuki O. et al. Individualized treatment sequencing selection contributes to optimized survival in patients with rectal cancer and synchronous liver metastases. Ann Surg Oncol 2017; 24 (13) 3857-3864
    CrossrefPubMedGoogle Scholar
  • 11 Vallance AE, van der Meulen J, Kuryba A. et al. The timing of liver resection in patients with colorectal cancer and synchronous liver metastases: a population-based study of current practice and survival. Colorectal Dis 2018; 20 (06) 486-495
    CrossrefPubMedGoogle Scholar
  • 12 Fernández-Moreno MC, Dorcaratto D, Garcés-Albir M. et al. Impact of type and severity of postoperative complications on long-term outcomes after colorectal liver metastases resection. J Surg Oncol 2020; 122 (02) 212-225
    CrossrefPubMedGoogle Scholar
  • 13 Shubert CR, Habermann EB, Bergquist JR. et al. A NSQIP review of major morbidity and mortality of synchronous liver resection for colorectal metastasis stratified by extent of liver resection and type of colorectal resection. J Gastrointest Surg 2015; 19 (11) 1982-1994
    CrossrefPubMedGoogle Scholar
  • 14 Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg 2015; 261 (03) 497-505
    CrossrefPubMedGoogle Scholar
  • 15 Trejo-Avila M, Bozada-Gutiérrez K, Valenzuela-Salazar C, Herrera-Esquivel J, Moreno-Portillo M. Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36 (06) 1077-1096
    CrossrefPubMedGoogle Scholar
  • 16 Lee DU, Fan GH, Hastie DJ. et al. The clinical impact of malnutrition on the postoperative outcomes of patients undergoing colorectal resection surgery for colon or rectal cancer: propensity score matched analysis of 2011-2017 US hospitals. Surg Oncol 2021; 38: 101587
    CrossrefPubMedGoogle Scholar
  • 17 Hu WH, Eisenstein S, Parry L, Ramamoorthy S. Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study. Nutr J 2019; 18 (01) 33
    CrossrefPubMedGoogle Scholar
  • 18 Almasaudi AS, McSorley ST, Dolan RD, Edwards CA, McMillan DC. The relation between Malnutrition Universal Screening Tool (MUST), computed tomography-derived body composition, systemic inflammation, and clinical outcomes in patients undergoing surgery for colorectal cancer. Am J Clin Nutr 2019; 110 (06) 1327-1334
    CrossrefPubMedGoogle Scholar
  • 19 Meza-Valderrama D, Marco E, Dávalos-Yerovi V. et al. Sarcopenia, malnutrition, and cachexia: adapting definitions and terminology of nutritional disorders in older people with cancer. Nutrients 2021; 13 (03) 761
    CrossrefPubMedGoogle Scholar
  • 20 Lee DU, Wang E, Fan GH. et al. Malnutrition as a risk factor of adverse postoperative outcomes in patients undergoing hepatic resection: analysis of US hospitals. Br J Nutr 2022; 128 (04) 675-683
    CrossrefPubMedGoogle Scholar
  • 21 Pata G, Bianchetti L, Rota M. et al. Multidimensional Prognostic Index (MPI) score has the major impact on outcome prediction in elderly surgical patients with colorectal cancer: the FRAGIS study. J Surg Oncol 2021; 123 (02) 667-675
    CrossrefPubMedGoogle Scholar
  • 22 Richards SJG, Cherry TJ, Frizelle FA, Eglinton TW. Pre-operative frailty is predictive of adverse post-operative outcomes in colorectal cancer patients. ANZ J Surg 2021; 91 (03) 379-386
    CrossrefPubMedGoogle Scholar
  • 23 Michaud Maturana M, English WJ, Nandakumar M, Li Chen J, Dvorkin L. The impact of frailty on clinical outcomes in colorectal cancer surgery: a systematic literature review. ANZ J Surg 2021; 91 (11) 2322-2329
    CrossrefPubMedGoogle Scholar
  • 24 McKechnie T, Bao T, Fabbro M, Ruo L, Serrano PE. Frailty as a predictor of postoperative morbidity and mortality following liver resection. Am Surg 2021; 87 (04) 648-654
    CrossrefPubMedGoogle Scholar
  • 25 Nordlinger B, Guiguet M, Vaillant JC. et al; Association Française de Chirurgie. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Cancer 1996; 77 (07) 1254-1262
    CrossrefPubMedGoogle Scholar
  • 26 Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230 (03) 309-318 , discussion 318–321
    CrossrefPubMedGoogle Scholar
  • 27 Rees M, Tekkis PP, Welsh FK, O'Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 2008; 247 (01) 125-135
    CrossrefPubMedGoogle Scholar
  • 28 Konopke R, Kersting S, Distler M. et al. Prognostic factors and evaluation of a clinical score for predicting survival after resection of colorectal liver metastases. Liver Int 2009; 29 (01) 89-102
    CrossrefPubMedGoogle Scholar
  • 29 Zakaria S, Donohue JH, Que FG. et al. Hepatic resection for colorectal metastases: value for risk scoring systems?. Ann Surg 2007; 246 (02) 183-191
    CrossrefPubMedGoogle Scholar
  • 30 Schreckenbach T, Malkomes P, Bechstein WO, Woeste G, Schnitzbauer AA, Ulrich F. The clinical relevance of the Fong and the Nordlinger scores in the era of effective neoadjuvant chemotherapy for colorectal liver metastasis. Surg Today 2015; 45 (12) 1527-1534
    CrossrefPubMedGoogle Scholar
  • 31 Brudvik KW, Kopetz SE, Li L, Conrad C, Aloia TA, Vauthey JN. Meta-analysis of KRAS mutations and survival after resection of colorectal liver metastases. Br J Surg 2015; 102 (10) 1175-1183
    CrossrefPubMedGoogle Scholar
  • 32 Margonis GA, Spolverato G, Kim Y, Karagkounis G, Choti MA, Pawlik TM. Effect of KRAS mutation on long-term outcomes of patients undergoing hepatic resection for colorectal liver metastases. Ann Surg Oncol 2015; 22 (13) 4158-4165
    CrossrefPubMedGoogle Scholar
  • 33 Margonis GA, Buettner S, Andreatos N. et al. Association of BRAF mutations with survival and recurrence in surgically treated patients with metastatic colorectal liver cancer. JAMA Surg 2018; 153 (07) e180996
    CrossrefPubMedGoogle Scholar
  • 34 Tsilimigras DI, Ntanasis-Stathopoulos I, Bagante F. et al. Clinical significance and prognostic relevance of KRAS, BRAF, PI3K and TP53 genetic mutation analysis for resectable and unresectable colorectal liver metastases: a systematic review of the current evidence. Surg Oncol 2018; 27 (02) 280-288
    CrossrefPubMedGoogle Scholar
  • 35 Poultsides GA, Bao F, Servais EL. et al. Pathologic response to preoperative chemotherapy in colorectal liver metastases: fibrosis, not necrosis, predicts outcome. Ann Surg Oncol 2012; 19 (09) 2797-2804
    CrossrefPubMedGoogle Scholar
  • 36 Blazer III DG, Kishi Y, Maru DM. et al. Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol 2008; 26 (33) 5344-5351
    CrossrefPubMedGoogle Scholar
  • 37 Sebagh M, Allard MA, Cunha AS. et al. A proposed new method for assessing the pathological response to chemotherapy in resected colorectal liver metastases. Br J Cancer 2014; 111 (03) 470-476
    CrossrefPubMedGoogle Scholar
  • 38 Eisenhauer EA, Therasse P, Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45 (02) 228-247
    CrossrefPubMedGoogle Scholar
  • 39 Shindoh J, Loyer EM, Kopetz S. et al. Optimal morphologic response to preoperative chemotherapy: an alternate outcome end point before resection of hepatic colorectal metastases. J Clin Oncol 2012; 30 (36) 4566-4572
    CrossrefPubMedGoogle Scholar
  • 40 Lau LF, Williams DS, Lee ST, Scott AM, Christophi C, Muralidharan V. Metabolic response to preoperative chemotherapy predicts prognosis for patients undergoing surgical resection of colorectal cancer metastatic to the liver. Ann Surg Oncol 2014; 21 (07) 2420-2428
    CrossrefPubMedGoogle Scholar
  • 41 Silberhumer GR, Paty PB, Temple LK. et al. Simultaneous resection for rectal cancer with synchronous liver metastasis is a safe procedure. Am J Surg 2015; 209 (06) 935-942
    CrossrefPubMedGoogle Scholar
  • 42 Silberhumer GR, Paty PB, Denton B. et al. Long-term oncologic outcomes for simultaneous resection of synchronous metastatic liver and primary colorectal cancer. Surgery 2016; 160 (01) 67-73
    CrossrefPubMedGoogle Scholar
  • 43 Slesser AA, Chand M, Goldin R, Brown G, Tekkis PP, Mudan S. Outcomes of simultaneous resections for patients with synchronous colorectal liver metastases. Eur J Surg Oncol 2013; 39 (12) 1384-1393
    CrossrefPubMedGoogle Scholar
  • 44 Martin II RC, Augenstein V, Reuter NP, Scoggins CR, McMasters KM. Simultaneous versus staged resection for synchronous colorectal cancer liver metastases. J Am Coll Surg 2009; 208 (05) 842-850 , discussion 850–852
    CrossrefPubMedGoogle Scholar
  • 45 Mise Y, Mehran RJ, Aloia TA, Vauthey JN. Simultaneous lung resection via a transdiaphragmatic approach in patients undergoing liver resection for synchronous liver and lung metastases. Surgery 2014; 156 (05) 1197-1203
    CrossrefPubMedGoogle Scholar
  • 46 Yin Z, Liu C, Chen Y. et al. Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): Simultaneous or delayed?. Hepatology 2013; 57 (06) 2346-2357
    CrossrefPubMedGoogle Scholar
  • 47 Feng Q, Wei Y, Zhu D. et al. Timing of hepatectomy for resectable synchronous colorectal liver metastases: for whom simultaneous resection is more suitable--a meta-analysis. PLoS One 2014; 9 (08) e104348
    CrossrefPubMedGoogle Scholar
  • 48 Slesser AA, Simillis C, Goldin R, Brown G, Mudan S, Tekkis PP. A meta-analysis comparing simultaneous versus delayed resections in patients with synchronous colorectal liver metastases. Surg Oncol 2013; 22 (01) 36-47
    CrossrefPubMedGoogle Scholar
  • 49 Gavriilidis P, Katsanos K, Sutcliffe RP, Simopoulos C, Azoulay D, Roberts KJ. Simultaneous, delayed and liver-first hepatic resections for synchronous colorectal liver metastases: a systematic review and network meta-analysis. J Clin Med Res 2019; 11 (08) 572-582
    CrossrefPubMedGoogle Scholar
  • 50 Boudjema K, Locher C, Sabbagh C. et al; METASYNC Study group. Simultaneous versus delayed resection for initially resectable synchronous colorectal cancer liver metastases: a prospective, open-label, randomized, controlled trial. Ann Surg 2021; 273 (01) 49-56
    CrossrefPubMedGoogle Scholar
  • 51 Reddy SK, Pawlik TM, Zorzi D. et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 2007; 14 (12) 3481-3491
    CrossrefPubMedGoogle Scholar
  • 52 Snelgrove RC, Subendran J, Jhaveri K. et al. Effect of multidisciplinary cancer conference on treatment plan for patients with primary rectal cancer. Dis Colon Rectum 2015; 58 (07) 653-658
    CrossrefPubMedGoogle Scholar
  • 53 Karagkounis G, Stocchi L, Lavery IC. et al. Multidisciplinary conference and clinical management of rectal cancer. J Am Coll Surg 2018; 226 (05) 874-880
    CrossrefPubMedGoogle Scholar
  • 54 Jones RP, Vauthey JN, Adam R. et al. Effect of specialist decision-making on treatment strategies for colorectal liver metastases. Br J Surg 2012; 99 (09) 1263-1269
    CrossrefPubMedGoogle Scholar
  • 55 Choti MA, Thomas M, Wong SL. et al. Surgical resection preferences and perceptions among medical oncologists treating liver metastases from colorectal cancer. Ann Surg Oncol 2016; 23 (02) 375-381
    CrossrefPubMedGoogle Scholar
  • 56 Folprecht G, Gruenberger T, Bechstein WO. et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol 2010; 11 (01) 38-47
    CrossrefPubMedGoogle Scholar
  • 57 Garufi C, Torsello A, Tumolo S. et al. Cetuximab plus chronomodulated irinotecan, 5-fluorouracil, leucovorin and oxaliplatin as neoadjuvant chemotherapy in colorectal liver metastases: POCHER trial. Br J Cancer 2010; 103 (10) 1542-1547
    CrossrefPubMedGoogle Scholar
  • 58 Cremolini C, Casagrande M, Loupakis F. et al. Efficacy of FOLFOXIRI plus bevacizumab in liver-limited metastatic colorectal cancer: a pooled analysis of clinical studies by Gruppo Oncologico del Nord Ovest. Eur J Cancer 2017; 73: 74-84
    CrossrefPubMedGoogle Scholar
  • 59 Heinemann V, von Weikersthal LF, Decker T. et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol 2014; 15 (10) 1065-1075
    CrossrefPubMedGoogle Scholar
  • 60 Bokemeyer C, Bondarenko I, Makhson A. et al. Fluorouracil, leucovorin, and oxaliplatin with and without cetuximab in the first-line treatment of metastatic colorectal cancer. J Clin Oncol 2009; 27 (05) 663-671
    CrossrefPubMedGoogle Scholar
  • 61 Van Cutsem E, Köhne CH, Hitre E. et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med 2009; 360 (14) 1408-1417
    CrossrefPubMedGoogle Scholar
  • 62 Folprecht G, Gruenberger T, Bechstein W. et al. Survival of patients with initially unresectable colorectal liver metastases treated with FOLFOX/cetuximab or FOLFIRI/cetuximab in a multidisciplinary concept (CELIM study). Ann Oncol 2014; 25 (05) 1018-1025
    CrossrefPubMedGoogle Scholar
  • 63 Nordlinger B, Sorbye H, Glimelius B. et al; EORTC Gastro-Intestinal Tract Cancer Group; Cancer Research UK; Arbeitsgruppe Lebermetastasen und-tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO); Australasian Gastro-Intestinal Trials Group (AGITG); Fédération Francophone de Cancérologie Digestive (FFCD) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 2008; 371 9617 1007-1016
    CrossrefPubMedGoogle Scholar
  • 64 Nordlinger B, Sorbye H, Glimelius B. et al; EORTC Gastro-Intestinal Tract Cancer Group; Cancer Research UK; Arbeitsgruppe Lebermetastasen und–tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO); Australasian Gastro-Intestinal Trials Group (AGITG)Fédération Francophone de Cancérologie Digestive (FFCD) Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983); long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol 2013; 14 (12) 1208-1215
    CrossrefPubMedGoogle Scholar
  • 65 Vauthey JN, Pawlik TM, Ribero D. et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 2006; 24 (13) 2065-2072
    CrossrefPubMedGoogle Scholar
  • 66 Kishi Y, Zorzi D, Contreras CM. et al. Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases. Ann Surg Oncol 2010; 17 (11) 2870-2876
    CrossrefPubMedGoogle Scholar
  • 67 Cameron MG, Kersten C, Vistad I, Fosså S, Guren MG. Palliative pelvic radiotherapy of symptomatic incurable rectal cancer - a systematic review. Acta Oncol 2014; 53 (02) 164-173
    CrossrefPubMedGoogle Scholar
  • 68 Kapiteijn E, Marijnen CA, Nagtegaal ID. et al; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345 (09) 638-646
    CrossrefPubMedGoogle Scholar
  • 69 van Gijn W, Marijnen CA, Nagtegaal ID. et al; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011; 12 (06) 575-582
    CrossrefPubMedGoogle Scholar
  • 70 Schrag D, Weiser MR, Goodman KA. et al. Neoadjuvant chemotherapy without routine use of radiation therapy for patients with locally advanced rectal cancer: a pilot trial. J Clin Oncol 2014; 32 (06) 513-518
    CrossrefPubMedGoogle Scholar
  • 71 Goodman KA, Patton CE, Fisher GA. et al. Appropriate customization of radiation therapy for stage II and III rectal cancer: executive summary of an ASTRO Clinical Practice Statement using the RAND/UCLA Appropriateness Method. Pract Radiat Oncol 2016; 6 (03) 166-175
    CrossrefPubMedGoogle Scholar
  • 72 Berber E, Tsinberg M, Tellioglu G, Simpfendorfer CH, Siperstein AE. Resection versus laparoscopic radiofrequency thermal ablation of solitary colorectal liver metastasis. J Gastrointest Surg 2008; 12 (11) 1967-1972
    CrossrefPubMedGoogle Scholar
  • 73 Kim KH, Yoon YS, Yu CS. et al. Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases. J Korean Surg Soc 2011; 81 (01) 25-34
    CrossrefPubMedGoogle Scholar
  • 74 Lee H, Heo JS, Cho YB. et al. Hepatectomy vs radiofrequency ablation for colorectal liver metastasis: a propensity score analysis. World J Gastroenterol 2015; 21 (11) 3300-3307
    CrossrefPubMedGoogle Scholar
  • 75 Aloia TA, Vauthey JN, Loyer EM. et al. Solitary colorectal liver metastasis: resection determines outcome. Arch Surg 2006; 141 (05) 460-466 , discussion 466–467
    CrossrefPubMedGoogle Scholar
  • 76 Raoux L, Maulat C, Mokrane FZ, Fares N, Suc B, Muscari F. Impact of the strategy for curative treatment of synchronous colorectal cancer liver metastases. J Visc Surg 2020; 157 (04) 289-299
    CrossrefPubMedGoogle Scholar