Timing of resection and treatment of colorectal cancer (CRC) with liver metastases varies based on patient characteristics and center protocols. Concerns of increased morbidity and mortality (M&M) related to anesthetic time and blood loss have limited widespread adaptation of synchronous colorectal and liver resections. Furthermore, technical challenges have made minimally invasive synchronous resections less common. We present our series of synchronous robotic surgery for CRC with liver metastases. Retrospective review of prospectively collected data of patients with stage IV CRC with liver metastases treated at a tertiary center from February 2013 to June 2014. Patients who underwent synchronous robotic surgery for CRC with liver metastasis(es) were included and selected by a multidisciplinary cancer committee. Data included patient demographics, disease stage, OR time, EBL, and complications. All resections were performed robotically by the same well-experienced surgeons. A radiologist was present for intraoperative ultrasound. Liver treatment was performed first in consideration of intraoperative bleeding risk. Sixty-six patients with Stage IV CRC were seen at the tertiary center during the study period. Six patients met inclusion criteria (2 male, 4 female). Mean age was 59.3 years and mean BMI was 23.46. Mean of 2.25 liver segments were resected and mean of 1.75 liver segments were ablated. Four patients underwent metastatectomy; three with concurrent microwave ablation. One patient had ablation without resection and another had no identifiable lesion on ultrasound. The colonic resections included 3 low anterior resections, 2 abdominal perineal resections (APR), and 1 right hemicolectomy. Mean operative time was 401 min (349-506 min) with mean EBL of 316 mL (150-1000 mL). No conversions to an open approach occurred. Median length of stay (LOS) was 4.5 days (3-10 days). Complications included delayed wound healing after an APR and a delayed rectal anastomotic failure after ileostomy reversal. There was no 30-day mortality. At a mean follow-up of 19 months, one death occurred at 26 months and the remaining patients had documented metastatic disease. Synchronous resection for metastatic CRC carries risks. We report our series of synchronous robotic surgery for CRC with liver metastases. The robotic approach contributed to low blood loss, appropriate LOS, and no 30-day mortality. Morbidity experienced was consistent with the procedures and not related to the robotic technique. This series supports the potential benefits of synchronous resection from a technical standpoint. Further data are required to determine treatment and survival benefits. Limitations include small number and retrospective review of data.
C olonoscopy has become an invaluable tool in the diagnosis and treatment of diseases of the colon and rectum. The most common complications are bleeding and perforation, which occur in up to one percent of patients undergoing diagnostic colonoscopy and three percent of patients undergoing therapeutic colonoscopy. 1 Less common complications include pneumothorax, pneumomediastinum, mesenteric tear and colonic volvulus. Splenic rupture is a rare colonoscopic complication, with only 24 cases reported in American literature 2-23 and 11 additional cases reported in foreign literature. 24 -34 The first case of splenic rupture resulting from colonoscopy was reported in 1974 by Wherry and Zhener. 2 We present our experience with a case of splenic rupture after colonoscopy in a 59-year-old woman managed without surgical intervention. CASE REPORTA 59-year-old white woman with a family history of colon cancer underwent a screening colonoscopy. Her surgical history included a total abdominal hysterectomy and a subsequent salpingo-oophorectomy. The colonoscopy was performed without difficulty. Diagnostic findings were a tortuous left colon, hemorrhoids and rare diverticuli. No polyps or cancer were seen. The post-sedation recovery was uneventful and the patient felt well with no complaints upon routine discharge.Five hours after discharge the patient developed severe left-sided abdominal pain that radiated to the tip of her left shoulder. At assessment in the emergency room her heart rate was 97 bpm and blood pressure 141/79 mm Hg. Bowel sounds were normal, abdomen soft and non-distended with generalized tenderness. Abdominal films revealed gas within a non-distended colon, but no free air present. The patient was resuscitated with IV fluids and admitted to the intensive care unit by the medicine serivce. The hemoglobin level decreased from 12.0 g/DL to 6.6g/DL at 20 hours after admission. A resultant progressive tachycardia and low systolic blood pressure accompanied the decreasing hemoglobin level resulting in surgical consultation. Computed tomography (CT) revealed a Grade II-III splenic injury with no active extravasation (Fig. 1). A 14.4 ϫ 9.6 cm splenic hematoma extended down the left pericolic gutter into the pelvis and the liver was surrounded with a moderate amount of low density fluid consistent with free blood.Four units of packed red blood cells were administered and within the first 24 hours vital signs normalized and serial hemoglobin tests showed no evidence of active bleeding. Because there was no active bleeding or free air, and the splenic injury was Grade II-III, non-operative management was continued. By 27 hours after admission, the hemoglobin stabilized at 12.1 g/DL and did not significantly decline for the remainder of her hospitalization. Partial resolution of the hemoperitoneum and subcapsular splenic hematoma were seen on a follow-up CT scan on the 9th day (Fig. 2). The patient continued to improve clinically and was discharged home on the 10th day.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.