Synchronous liver metastases (SLMs) are found in 15%e25% of patients at the time the presentation with colorectal cancer, which is limited to the liver in 30%. Surgical resection is the most effective and potential curative therapy for metastatic colorectal carcinoma (CRC) to the liver. Simultaneous resection of primary CRC and synchronous liver metastases is subject of debate with respect to morbidity in comparison to staged resection. Minimally invasive laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens hospitalization, and yields superior cosmetic results, without compromising oncological outcome. The aim of this study is therefore to evaluate our initial experiences of simultaneous laparoscopic resection of primary CRC and SLM. Methods: Currently, laparoscopic resection of primary CRC is performed in more than 53% of all patients in our surgical department. 18 patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. 6 of them underwent laparoscopic colorectal resection combine by major laparoscopic liver resection. Results: Surgical approach was total laparoscopic (17 patients) or hand-assisted laparoscopic (1 patients). The incision created for the extraction of the specimen varied between 5 and 8cm. Median operation time was 245 (range 150e320) minutes with a total blood loss of 600 (range 200-750) ml. Postoperative hospital stay was 7day (5e12). An R0 resection was achieved in all patients. Conclusions: Simultaneous laparoscopic colorectal and liver resection appears to be save and feasible in selected patients with CRC and SLM, with satisfying short-term results.
Background: Borderline pancreatic adenocarcinoma (BPAC) may be technically resectable with high risks of R1 resection and postoperative recurrence. Neoadjuvant chemotherapy (NAC) is used without clear consensus. We present the preliminary Results of multidisciplinary management of BPAC patients Methods: We adopted the definition of the National Comprehensive Cancer Network (NCCN) for BPAC. All patients received neoadjuvant chemotherapy with at minimum 4 cures. The goal of this study was to investigate the morbidity and survival after surgical resection depending on the quality of oncological resection. Results: From September 2012 to December 2018,120 patients underwent pancreaticoduodenectomy (PD) for adenocarcinoma of the head of the pancreas. Among them, 34 (28%) had BPAC. Vascular resection was performed in 32% of patient. R0 resection was achieved in 56% of cases and R1 in 44%. According to surgical margin, R1 resections were divided into R1 0mm (54%) and R1 low ]0,1 mm[ (46%) Ninety-day mortality was nil. A pancreatic fistula occurred in 6% of patients. In terms of survival, overall (p=0.71) and recurrence-free (P=0.32) survival were similar to those in patients with resectable tumors. Same findings were noted between R0 et R1 low (p=0.72). Survival was statistically lower in the group R1 0mm when compared to survival of R0 group (P=0.05). Conclusions: Using a multidisciplinary approach to manage BPAC, good outcome could be achieved. Oncological quality of resection with at least R1 low resection is of paramount importance to ensure optimal survival.
19e1096). Patients undergoing resection survived longer (median 724 days) compared with those treated palliatively (median 498 days) (p = 0.02). Procedures carried out were 57(53%)PPPD, 5(7%) whipples procedure, 20(18%)Liver resection, 8(12%)bile duct excision. 48(70%) of resections were preformed for distal bile duct, 10(14%) hilar and 11(16%) intrahepatic lesions. Of the resected tumours 38(55%) were stage 1, 29(42%) were stage 2 and 2 (3%) were stage 3. Patients with intrahepatic tumours were most likely to undergo R0 resections compared with hilar or distal bile duct lesions (10/11 (82%), 6/9 (66%) and 34/48 (71%) respectively). Similarly patients with intrahepatic tumours had reduced lymph node positivity compared with the other groups (1/11 (9%), 2/9 (22%) and 13/48 (27%) respectively). Variables correlated to reduced survival time included R1 resection (P = 0.01), lymph node positivity (p = 0.04), and a pre-operative albumin of below 28 (p = 0.01) Conclusions: Resection prolongs survival for patients withcholangiocarcinoma. Survival duration was reduced if patients had low pre-operative serum albumin levels, R1 resection, or histologically positive lymph nodes.
Synchronous liver metastases (SLMs) are found in 15%e25% of patients at the time the presentation with colorectal cancer, which is limited to the liver in 30%. Surgical resection is the most effective and potential curative therapy for metastatic colorectal carcinoma (CRC) to the liver. Simultaneous resection of primary CRC and synchronous liver metastases is subject of debate with respect to morbidity in comparison to staged resection. Minimally invasive laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens hospitalization, and yields superior cosmetic results, without compromising oncological outcome. The aim of this study is therefore to evaluate our initial experiences of simultaneous laparoscopic resection of primary CRC and SLM. Methods: Currently, laparoscopic resection of primary CRC is performed in more than 53% of all patients in our surgical department. 18 patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. 6 of them underwent laparoscopic colorectal resection combine by major laparoscopic liver resection. Results: Surgical approach was total laparoscopic (17 patients) or hand-assisted laparoscopic (1 patients). The incision created for the extraction of the specimen varied between 5 and 8cm. Median operation time was 245 (range 150e320) minutes with a total blood loss of 600 (range 200-750) ml. Postoperative hospital stay was 7day (5e12). An R0 resection was achieved in all patients. Conclusions: Simultaneous laparoscopic colorectal and liver resection appears to be save and feasible in selected patients with CRC and SLM, with satisfying short-term results.
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