Synchronous Liver and Peritoneal Metastases: From Contraindication to Feasibility of Combined Surgery in Advanced Colorectal Cancer

Colorectal cancer (CRC) ranks as the third most prevalent cancer globally, with 25% of patients presenting with metastases; of these, 8% have synchronous liver and peritoneal metastases. Although the concurrent presence of liver and peritoneal metastases was previously considered an absolute contraindication, the feasibility of combined surgery is now being re-evaluated. This study assesses 41 patients who underwent liver surgery for CRC metastases at our center between October 2021 and February 2024. Among these patients, 7 underwent concomitant cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) due to the presence of synchronous liver and peritoneal metastases. We employed simple linear regression to identify parameters that influenced the development of postoperative complications, classified by the Clavien-Dindo (CD) system. The statistical analysis showed only the operative time, the CRS+HIPEC procedure and the length of hospital stay as significative variables on CD outcome, while the different types of liver surgery were not significant. This study suggests that combining liver surgery with CRS+HIPEC may be beneficial for selected patients, potentially improving overall survival without a significant increase in postoperative complications. A multidisciplinary approach is essential to achieve a survival advantage without elevating morbidity rates.