Simultaneous Bowel and Liver Surgery

What simultaneous surgery is

Metastases are called synchronous if they are found at the same time as the bowel tumor or shortly after it, and metachronous if they appear later, during follow-up. The question of a simultaneous operation arises precisely with synchronous metastases: the bowel tumor is still in place, and the liver already has lesions that can be removed.

A simultaneous operation is the removal of the bowel tumor and the liver metastases under one anesthetic. The patient goes through one procedure, one hospital stay and one recovery instead of two. But the risks of two operations also add up in one, so this option does not suit everyone.

The disease itself, tests and prognosis are described on the page “Colorectal Liver Metastases”.

Who simultaneous surgery suits

It is considered if:

• the bowel tumor and all liver lesions can be removed completely, with clear margins;
• after resection enough liver will remain with its own blood supply and bile drainage;
• there is no uncontrolled tumor spread beyond the liver;
• the combined extent of both procedures is moderate and the patient’s general condition allows such an operation.

Whether prior treatment is needed is also taken into account. As a first step, simultaneous surgery is most often considered for a colon tumor with a minor liver resection; for rectal cancer a separate sequence is usually planned. The larger both stages are — for example, a major liver resection together with complex rectal surgery — the higher the combined risk and the more often a staged approach is chosen.

When staged surgery is better

A staged approach is not a “worse” option but a way to reduce the risk of an excessive simultaneous procedure. If you have been told that surgery is impossible, it makes sense to show current images for a surgeon’s second opinion.

How the operation is performed

The extent on the bowel is determined by the tumor location — just as in a separate bowel cancer operation or rectal cancer operation. The extent on the liver ranges from removal of individual sections to removal of a lobe. During surgery the liver is examined with an ultrasound probe to find lesions not visible on imaging.

Small lesions deep in the liver may be destroyed with radiofrequency ablation instead of being removed — this preserves more healthy tissue.

When the extent of both procedures and previous operations allow it, surgery is performed laparoscopically — through small incisions in the abdomen, without a large incision. This means less surgical trauma and faster recovery, which matters for patients who need to continue chemotherapy after surgery. Otherwise surgery is open.

Hospital stay, recovery and further treatment

Recovery follows the enhanced recovery (ERAS) protocol: early mobilization, early eating, controlled pain relief. The length of the hospital stay depends on the extent of both stages and the approach.

Chemotherapy after surgery starts once the wound has healed and liver function tests have returned to normal. The exact timing is set by the medical oncologist together with the surgeon. After that — regular follow-up: CT or MRI and CEA levels on the schedule set by the doctor. A new lesion appearing later does not mean that surgical options have been exhausted: repeat resection or ablation is possible.

Risks and complications

In a simultaneous operation the risks of both procedures add up. The main ones are:

• anastomotic leak — when the join in the bowel does not heal;
• liver failure — with an insufficient volume or function of the liver remnant;
• bile leak from the liver resection surface;
• bleeding, infection and general surgical complications, including thrombosis.

This is exactly why a simultaneous operation is offered only when the combined extent of the procedures is moderate. I will explain the risks in your particular case at the consultation.

What the cost depends on

The cost depends on the extent of surgery on the bowel and the liver, the approach, whether resection is combined with ablation, the number of days in the hospital and the tests. The exact amount is named once the treatment plan has been defined. The payment can be split into parts — installments are available. The in-person consultation is free. More details are on the page “Cost of Surgery: What It Depends On”.

What documents are needed and how to book

• contrast-enhanced chest and abdominal CT and liver MRI discs — the discs with the images themselves;
• the colonoscopy report and the histopathology report of the bowel tumor and, if available, molecular test results;
• for a rectal tumor — pelvic MRI;
• summaries of treatment, if it has already started, including chemotherapy regimens and the number of cycles;
• recent blood tests, including liver function tests and CEA.

Book a consultation by phone or through the form. If you are from another city, send the documents in advance — how to do this is described on the page “Online Oncologist Consultation”.