Ann Hepatobiliary Pancreat Surg.  2016 Nov;20(4):167-172. 10.14701/ahbps.2016.20.4.167.

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

• Takorov I
• Belev N
• Lukanova T
• Atanasov B
• Dzharov G
• Djurkov V
• Odisseeva
• Vladov N

• KMID: 2362466
• DOI: http://doi.org/10.14701/ahbps.2016.20.4.167

Abstract

BACKGROUNDS/AIMS
Synchronous 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.
METHODS
Currently, 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.
RESULTS
The 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%).
CONCLUSIONS
Simultaneous laparoscopic colorectal and liver resection appears to be safe, feasible, and with satisfying short-term results in selected patients with CRC and SLM.

Keyword

Simultaneous laparoscopic colorectal and liver resections; Major laparoscopic liver resections; Colorectal cancer; Synchronous colorectal liver metastases

MeSH Terms

Colorectal Neoplasms*
Diagnosis
Hospitalization
Humans
Laparoscopy
Length of Stay
Liver*
Neoplasm Metastasis*
Pain, Postoperative
Postoperative Complications
Wound Infection

Figure

• 

  Fig. 1 Localization of trocars and number of ports in combined liver and colorectal laparoscopic resections.

• 

  Fig. 2 Primary localization of colorectal cancer.

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