Clinical effect of laparoscopic I-stage resection for colorectal liver metastasis

Abstract

Objective To investigate the safety, feasibility and clinical effect of laparoscopic Ⅰ-stage resection of colorectal liver metastasis (CRLM). Methods The retrospective cohort study was adopted. The clinicopathological data of 11 patients who underwent laparoscopic Ⅰ-stage resection of CRLM at the Affiliated Tumor Hospital of Zhengzhou University from February 2012 to October 2015 were collected. The primary lesions were confirmed by preoperative colonoscopy, abdominal CT and pathological biopsy, and liver metastases were diagnosed by abdominal enhanced CT or MRI. Patients selected preoperative individualized adjuvant therapy according to their conditions, and then underwent laparoscopic Ⅰ-stage resection of CRLM. After operation, patients received adjuvant chemotherapy of FOLFOX6 (oxaliplatin+ calcium folinate+ fluorouracil) or FOLFRIRI (irinotecan+ calcium folinate+ fluorouracil) regimens. The pre-, intra- and post-operative indexes were recorded, including (1) location and diameter of tumor and preoperative treatment; (2) surgical method, volume of intraoperative blood loss, operation time, resection margin and number of lymph node dissected; (3) complications, result of pathological examination, time of gastrointestinal function recovery, time for diet intake, duration of hospital stay, adjuvant therapy and recurrence of tumor. Patients were followed up by outpatient examination and telephone interview. The regular reexaminations of tumor marker, ultrasound and abdominal CT were applied to patients for detecting the recurrence of tumor till November 2015. Measurement data with normal distribution and with skewed distribution were presented as ±s and M(range), respectively. Results (1)Preoperative indexes: ascending colon cancer was detected in 2 patients, descending colon cancer in 1 patient, sigmoid cancer in 2 patients and rectal cancer in 6 patients. There were 6 solitary liver metastases with tumor diameter of 2.0-5.0 cm and 5 multiple liver metastases with average tumor number of 2.4 and tumor diameter of 1.0-4.0 cm. Four patients underwent preoperative neoadjuvant chemotherapy and 1 with rectal cancer underwent neoadjuvant radiotherapy. (2) Intra-operative status: all the 11 patients received successful laparoscopic Ⅰ-stage resection of CRLM. Laparoscopic liver irregular wedge resection was performed in 7 patients, regular hepatic lobes resection in 4 patients, left hemicolec-tomy in 2 patients, right hemicolectomy in 2 patients, Miles operation in 4 patients and Dixon operation in 3 patients. The operation time and volume of intraoperative blood loss were (245±61)minutes and (400±277)mL, without the occurrence of uncontrollable bleeding. The distal and proximal resection margins of colorectal cancer specimens (R0 resection) and circumferential resection margin of rectal cancer were negative. The median number of lymph node dissected, positive lymph node, negative resection margin of liver tumor (R0 resection)and positive laparoscopic resection margin (R1 resection) were 16 (range, 11-27), 0 (range, 0-7), 10 and 1, respectively. (3) Postoperative status: 2 patients had postoperative complications including 1 with intra peritoneal effusion and 1 with intraperitoneal infection, without occurrence of bile leakage, abdominal bleeding, anastomotic leakage, subphrenic abscess and hepatic failure. The time of postoperative gastrointestinal function recovery, time for diet intake and duration of hospital stay were (3.0±0.6)days, (3.0±0.9)days and (11.0±4.0)days, respectively. All the 11 patients underwent adjuvant chemotherapy of FOLFOX6 regimen, and 1 of 11 patients changed FOLFOX6 regimen into FOLFRIRI regimen due to recurrence of liver metastases. All the patients were followed up for a median time of 17 months (range, 2-44 months). During the follow-up, 1 patient died of pulmonary, brain and abdominal metastases and 10 patients had survival without recurrence of tumor except 1 with recurrence of liver metastasis. Conclusion Laparoscopic Ⅰ-stage resection of CRLM is safe and feasible for eligible patients, with a satisfactory short-term outcome. Key words: Colorectal neoplasms; Liver metastases; Laparoscopy