Laparoscopic combined colorectal and liver resections for primary colorectal cancer with synchronous liver metastases

Abstract

Backgrounds/AimsSynchronous liver metastases (SLMs) are found in 15-25% of patients at the time of diagnosis with colorectal cancer, which is limited to the liver in 30% of patients. Surgical resection is the most effective and potentially curative therapy for metastatic colorectal carcinoma (CRC) of the liver. The comparison of simultaneous resection of primary CRC and synchronous liver metastases with staged resections is the subject of debate with respect to morbidity. Laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens hospitalization, and yields superior cosmetic results, without compromising the oncological outcome. The aim of this study is therefore to evaluate our initial experience with simultaneous laparoscopic resection of primary CRC and SLM.MethodsCurrently, laparoscopic resection of primary CRC is performed in more than 53% of all patients in our surgical department. Twenty-six patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. Six of them underwent laparoscopic colorectal resection combined with major laparoscopic liver resection.ResultsThe surgical approaches were total laparoscopic (25 patients) or hybrid technique (1 patients). The incision created for the extraction of the specimen varied between 5 and 8cm. The median operation time was 223 minutes (100 to 415 min.) with a total blood loss of 180 ml (100-300 ml). Postoperative hospital stay was 6.8 days (6-14 days). Postoperative complications were observed in 6 patients (22.2%).ConclusionsSimultaneous laparoscopic colorectal and liver resection appears to be safe, feasible, and with satisfying short-term results in selected patients with CRC and SLM.

Simultaneous pure laparoscopic resection of primary colorectal cancer and synchronous liver metastases: a single institution experience with propensity score matching analysis

“…Interestingly, despite laparoscopy has the potential to reduce the incisional hernia rates, none of the studies on the present topic investigated this parameter which is responsible for long-term morbidity. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 35 In the present study none of the LAP whereas three patients from the OPEN group developed incisional hernia, but the difference was not significant.…”

“…There is an ongoing effort to show the potential benefit of totally laparoscopic strategies for the radical treatment of stage IV colorectal cancer. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 35 …”

“… 29 However, these relevant parameters were not reported in several previous analyses. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 35 …”

“… 19 Surprisingly, in several other reports on this topic pain control was not investigated. 13 , 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 Some surgeons combined a laparoscopic colorectal resection with an open procedure for the liver, as reported by Hatwell et al . 20 However, this technique also left a large incision in the upper abdomen, and the advantage of laparoscopy was not realized fully.…”

Simultaneous Hepatectomy as a Safe Approach for Synchronous Colorectal Liver Metastasis

“…to laparoscopic colorectal surgery alone; with carefully selected patients, especially those who require a minor hepatectomy. [11][12][13] In our study, over 30.0% of the simultaneous group underwent treatment via laparoscopic fashion, which showed no increased risk of major complications. Major hepatectomies, classified as a hepatectomy with at least three segments, is usually associated with more surgical complications.…”