Initial Experiences of Simultaneous Laparoscopic Resection of Colorectal Cancer and Liver Metastases

L T Hoekstra,T M Van Gulik,O R C Busch,W A Bemelman,P J Tanis

doi:10.1155/2012/893956

L T Hoekstra, T M Van Gulik + Show 3 more

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https://doi.org/10.1155/2012/893956

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Journal: HPB Surgery	Publication Date: Oct 2, 2012
Citations: 37	License type: CC BY 3.0

Affiliation: University of Amsterdam

Abstract

Introduction. Simultaneous resection of primary colorectal carcinoma (CRC) and synchronous liver metastases (SLMs) is subject of debate with respect to morbidity in comparison to staged resection. The aim of this study was to evaluate our initial experience with this approach. Methods. Five patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. Patient and tumor characteristics, operative variables, and postoperative outcomes were evaluated retrospectively. Results. The primary tumor was located in the colon in two patients and in the rectum in three patients. The SLM was solitary in four patients and multiple in the remaining patient. Surgical approach was total laparoscopic (2 patients) or hand-assisted laparoscopic (3 patients). The midline umbilical or transverse suprapubic incision created for the hand port and/or extraction of the specimen varied between 5 and 10 cm. Median operation time was 303 (range 151–384) minutes with a total blood loss of 700 (range 200–850) mL. Postoperative hospital stay was 5, 5, 9, 14, and 30 days. An R0 resection was achieved in all patients. Conclusions. From this initial single-center experience, simultaneous laparoscopic colorectal and liver resection appears to be feasible in selected patients with CRC and SLM, with satisfying short-term results.

Highlights

Simultaneous resection of primary colorectal carcinoma (CRC) and synchronous liver metastases (SLMs) is subject of debate with respect to morbidity in comparison to staged resection
Treatment decisions in patients with CRC and SLM were based on location and complexity of resection of the primary tumor, extent of liver resection, feasibility of a laparoscopic approach, and physical condition of the patient
The institutional protocol of the Academic Medical Center indicates that simultaneous resection is preferred in patients who require minor liver resection (

Summary

Introduction

Simultaneous resection of primary colorectal carcinoma (CRC) and synchronous liver metastases (SLMs) is subject of debate with respect to morbidity in comparison to staged resection. Five patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. From this initial single-center experience, simultaneous laparoscopic colorectal and liver resection appears to be feasible in selected patients with CRC and SLM, with satisfying short-term results. The liver is the most common site of hematogenous spread of primary colorectal carcinoma (CRC) [1, 2] and is affected in approximately 10–25% of patients having surgery [3]. Invasive laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens hospitalization, propagates rapid return to full activity, and yields superior cosmetic results, without compromising oncological outcome [7, 8]. Laparoscopic resection of primary CRC is performed in more than 40% of all patients in The Netherlands according to the Dutch Surgical Colorectal Audit [9]. The use of laparoscopy in liver surgery is still limited in The Netherlands [10]

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