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 a 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.
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 the simultaneous versus staged surgical treatment.
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.
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 to patients who required minor liver resection
(WR = 1.55, 95%CI 1.44–1.70).
Staged resection was superior to simultaneous resection for sCRLM based on a WR assessment.
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