Abstract / Summary
Approximately 30% of patients with colorectal carcinoma develop colorectal liver metastases (CRLM), and curative-intent hepatic resection (HRx) offers the best chance of long-term survival. For synchronous CRLM, the optimal sequencing of colorectal and HRx remains debated, and reliable biomarkers to refine prognostication are lacking. This study compared long-term outcomes of staged versus simultaneous resection for synchronous CRLM and evaluated the prognostic value of the Annexin V-binding apoptotic index (a surrogate marker related to ANXA5. We retrospectively analyzed 52 consecutive patients with synchronous CRLM who underwent curative-intent HRx between July 2007 and July 2024, classified as staged ( n = 32) or simultaneous ( n = 20) resection. Perioperative outcomes, clinicopathological features, and Annexin V-binding apoptotic index (assessed by flow cytometry; cut-off 25.5% by ROC analysis) were compared. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan–Meier method, and independent prognostic factors were identified by multivariable Cox regression. No significant differences were observed in demographics, tumor characteristics, or major complication rates between groups. Intensive care unit (ICU) stay (3 vs. 1 day, p = 0.025) and hospital stay (13 vs. 8 days, p < 0.001) were significantly longer after simultaneous resection. Three-year DFS was numerically higher in the staged group (21.9% vs. 10.0%, p = 0.059), while OS showed a similar non-significant trend ( p = 0.068). On multivariable analysis, rectal primary tumor location (HRx = 2.48, p = 0.027) and lymph node metastasis (LNM) (HRx = 2.44, p = 0.025) were independently associated with worse OS; LNM also independently predicted worse DFS (HRx = 2.01, p = 0.045). Annexin V-binding apoptotic index was not significantly associated with OS or DFS. Primary tumor location and LNM, rather than surgical timing, were independently associated with long-term outcomes after curative resection for synchronous CRLM. In the subgroup undergoing minor hepatectomy, no significant differences in OS or DFS were observed between staged and simultaneous resection. These findings are exploratory and do not establish equivalence between the two surgical strategies. Annexin V-binding apoptotic index was not significantly associated with survival in this cohort.