Combined Liver and Colorectal Resection for Metastatic Colorectal Carcinoma: Institutional Experience and Clinical Outcomes

Abstract

Introduction: Many patients with colorectal carcinoma present with liver metastases. Resection of both colorectal carcinomas and hepatic metastases brings potential for cure, but no consensus supports the resections should be concomitant. This study was undertaken to evaluate our initial outcomes with combined colorectal and hepatic resections. Methods: With IRB approval, we prospectively followed 26 consecutive patients who underwent combined liver and colorectal resections. ‘Major liver resection’ was defined as resection of ≥ 3 contiguous Couinaud segments. For illustrative purposes, data are presented as median(mean±SD). Results: Patients were 64(63±14.0) years old, 73% men, BMI of 29(29±5.7) kg/m2; 54% had previous abdominal operation(s). 62% underwent major liver resection; 77% had a robotic resection (no conversions to ‘open’). EBL was 150(210±181.8) mL. Total operative duration was 446(463±93.6) minutes with duration for liver resections being 206(226±103.0) minutes. All margins were R0. 3 patients developed postoperative complications of Clavien-Dindo score ≥III: 1 anastomotic leak requiring ileostomy, 1 effusion requiring thoracentesis, and 1 ascites requiring large-volume paracentesis. Length of stay was 5(6±3.5) days with 3 perioperative readmissions: 1 pleural effusion, 1 port site infection, and 1 fluid collection requiring percutaneous drainage. There were no deaths within 90 days. There were no differences in any metrics between robotic and ‘open’ operations. Conclusion: Concomitant liver and colon resections have shown to be safe and efficacious either via ‘open’ or robotic approach. For patients with metastatic colorectal cancer, our initial outcomes support concomitant colon and liver resections and the robotic approach.