Efficacy of laparoscopic colorectal radical resection combined with simultaneous laparoscopic or open major hepatectomy for synchronous colorectal liver metastases

Abstract

Objective To explore the clinical effect of laparoscopic colorectal radical resection combined with simultaneous laparoscopic or open major hepatectomy for synchronous colorectal liver metastases (SCRLM). Methods The retrospective cohort study was adopted. The clinical data of 14 patients with SCRLM who were admitted to the Peking University Third Hospital from July 2010 to September 2015 were collected. Seven patients undergoing total laparoscopic colorectal radical resection combined with major hepatectomy (TLCRMH) were allocated into the TLCRMH group and 7 patients undergoing laparoscopic colorectal radical resection combined with open major hepatectomy (LCROMH) were allocated into the LCROMH group. The statuses of colorectal cancer and metastatic lesions were detected by endoscopy and imaging examination, and diagnostic and therapeutic plans were confirmed through the consultation of multidisciplinary team. During the hepatectomy, total liver ultrasonography was performed and the extent of liver resection was above 3 hepatic segments. The follow-up of outpatient reexamination was applied to all the patients once every 3 months within postoperative year 2 and once every 6 months after 2 years till December 2015. (1) During operation, method of liver resection, radiofrequency ablation (RFA), operation time, volumes of intraoperative blood loss and blood transfusion, pathological results of primary lesions (T stage, N stage, nerve invasion and canalis haemalis invasion) were collected. (2)After operation, duration of intensive care unit (ICU) care, time for fluid diet intake, postoperative alanine transaminase (ALT), total bilirubin (TBil), complications and duration of hospital stay were collected. (3) Survival of patients and recurrence of tumor were followed up. Count data were analyzed by the chi-sqaure test. Measurement data with normal distribution were presented as ±s and analyzed using the t test. Measurement data with skewed distribution were described as M(Qn) and M(range) and analyzed using the Mann-Whitney U test. The survival curve was drawn by the Kaplan-Meier method, and overall survival rate and tumor-free survival rate were calculated. The survival analysis was done using the Log-rank test. Results (1) The status of operation: 1 and 6 patients in the TLCRMH group underwent respectively left and right hemihepatectomies and 7 patients in the LCROMH group underwent right hemihepatectomy. Four and 6 patients in the TLCRMH and LCROMH groups received local resection of liver metastatic lesions or RFA at segment Ⅱ, Ⅲ or Ⅳ of liver, respectively. The operation time, volumes of intraoperative blood loss and blood transfusion were (651±218)minutes, (1 387±871)mL, (914±641)mL in the TLCRMH group and (535±83)minutes, (1 357±991)mL, (857±360)mL in the LCROMH group, respectively, with no significant difference between the 2 groups (t=1.320, 0.060, 0.206, P>0.05). The numbers of patients in T2, T3, T4, N0, N1, N2 stages, with nerve invasion and canalis haemalis invasion were 1, 5, 1, 3, 4, 0, 3, 2 in the TLCRMH group and 0, 4, 3, 1, 4, 2, 2, 3 in the LCROMH group, respectively, showing no significant difference between the 2 groups (χ2=2.111, 3.000, 0.311, 0.311, P>0.05). (2) After operation, time for fluid diet intake, ALT, TBil, number of patients with complications and duration of hospital stay were (4.3±1.0)days, (105±47)U/L, (34±25)μmol/L, 3 (Ⅲa, Ⅲb and Ⅳa grades of Dindo-Clavien grade), (27±21)days in the TLCRMH group and (4.3±1.1)days, (113±57)U/L, (26±11)μmol/L, 4 (Ⅰ, Ⅰ, Ⅱ and Ⅳa grades of Dindo-Clavien grade), (19±9)days, respectively, showing no significant difference between the 2 groups (t=0.079, -0.286, 0.806, χ2=0.286, t=0.856, P>0.05). The duration of ICU care in the TLCRMH and LCROMH groups were (2.1±1.6)days and (1.0±0.6)days, with a significant difference between the 2 groups (t=1.804, P 0.05). The postoperative 1-, 2-year cumulative tumor-free survival rates and overage cumulative tumor-free survival time were 64.3%, 64.3% and 20.5 months in the TLCRMH group and 42.9%, 14.3% and 10.9 months in the LCROMH group, respectively, showing no significant difference between the 2 groups (χ2=3.160, P>0.05). Conclusion TLCRMH is safe and feasible for patients with SCLM, and it is comparable with LCROMH in the incidence of postoperative complication and long-term outcomes. Key words: Colorectal neoplasms; Liver metastases, syndronous; Surgery, simultaneous; Colorectal resection; Major hepatectomy; Laparoscopy