Clinical outcomes of laparoscopic-assisted synchronous bowel anastomoses for synchronous colorectal cancer: initial clinical experience

Abstract

The primary aim of this study was to explore the safety and feasibility of laparoscopic-assisted synchronous bowel anastomoses (LSBA) for synchronous colorectal cancer (SCRC). All patients who underwent LSBA for SCRC were retrospectively reviewed and analyzed for clinical and pathological features, technical feasibility and short-term as well as long-term oncological outcomes. Between July 2008 and January 2012, a series of 11 consecutive SCRC patients underwent LSBA. Six patients underwent laparoscopic-assisted right hemicolectomy and anterior resection. Five patients had laparoscopic-assisted right hemicolectomy and sigmoidectomy. There were no intraoperative complications that required open conversions. Mean operation time was 233 (range, 195–285) minutes, and mean estimated blood loss was 224 (range, 100–300) mL. The postoperative course of the patients was uneventful with the mean return to oral intake was 6.9 (range 5–12) days, and mean length of hospital stay was 12.6 (range 9–17) days. All surgical wounds showed good cosmetic outcome, and the mean incision length was 4.1 (range 3.5-5.0) cm. During a median follow-up period of 76 months, no local tumor recurrences were found. LSBA is a potentially feasible and safe procedure for SCRC when performed by an experienced surgeon. Further large clinical controlled trials are warranted to confirm the findings.

Quadruple advanced synchronous colorectal cancers successfully treated by laparoscopic surgery: a case report

“…As a surgical approach, laparoscopic surgery has significant advantages in terms of short-term outcomes including early recovery and no disadvantageous long-term outcomes. According to recent reports, laparoscopic surgery has been used in SCRCs [ 6 ], but these reports noted that controversy remains concerning operative procedures for multiple segmental resections and for total or subtotal colectomy. We report the case who presented with quadruple synchronous advanced cancers arising from the colon, which were successfully treated with laparoscopic two-segment colectomy.…”

Left Perforated Colonic Tumor with Synchronous Locally Advanced Right Colonic Tumor

“…Treatment variables include extended surgical resection with anastomosis when there are multiple tumors in the colon. It is also possible to perform segmental resections with anastomosis if the case allows [16, 17]. Among the complications of performing segmental resections are ileus and stenosis, while performing an extended resection, complications such as ileus, intestinal leakage, intra-abdominal collections, and mesenteric artery thrombosis can be expected [6, 16].…”

Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases

“…When SCRC are located in distant colonic segments, some authors suggest total or subtotal colectomy to remove synchronous tumours or polyps eventually undetected at preoperative imaging and to prevent the development of metachronous neoplasms[ 14 , 15 ]. In the same circumstances, other authors suggest more conservative surgical strategies, with resection of two intestinal segments (either open or laparoscopic-assisted)[ 13 , 16 - 18 ] and two anastomoses, seemingly resulting in a higher risk of anastomotic dehiscence[ 6 ].…”

“…Length of stay was seven (5-10) days, overall 30-day morbidity was 36% without anastomotic leaks or fistulas, and 30-day mortality was 3%. Li et al[ 18 ] examined a personal series of 11 patients and 52 adjunctive patients collected from six previous reports of the literature who underwent laparoscopic-assisted combined bowel anastomoses for SCRC, and concluded that combined bowel anastomoses are potentially feasible and safe procedures for SCRC when performed by experienced surgeons.…”

“…Conventional hemicolectomies or extended hemicolectomies can be indicated if multiple tumours are located in adjacent segments[ 12 ]. When SCRC are located in distant colonic segments, some authors suggest total or subtotal colectomy[ 14 , 15 ], while others suggest more conservative surgical strategies with resection of two intestinal segments, either open or laparoscopic-assisted[ 13 , 16 - 18 ], seemingly resulting in a higher risk of anastomotic dehiscence[ 6 ]. However, overall perioperative results of colorectal resections for SCRC seem to be worse than those of solitary CRC with more postoperative complications and reinterventions and longer hospital stays[ 6 ].…”