Simultaneous Laparoscopic Resection of Colorectal Cancer and Liver Metastases - Initial Experience

Abstract

Introduction: Synchronous liver metastases (SLMs) are found in 15% -25% of patients at the time their presentation with colorectal cancer, which is limited to the liver in 30% of the patients. Surgical resection is a potential curative therapy for metastatic colorectal carcinoma (CRC) directed to the liver, which is also the most effective one. Simultaneous resection of primary CRC and synchronous liver metastases is a subject of debate with respect to morbidity when compared to staged resection. Minimally invasive laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens the hospitalization period, and yields superior cosmetic results, without compromising the oncological outcome.The aim of this study is therefore to evaluate our initial experiences of simultaneous laparoscopic resection of primary CRC and SLM.Materials and Methods: Currently, laparoscopic resection of primary CRC is performed on more than 53% of all patients in our surgical department. 26 patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. 6 of them underwent laparoscopic colorectal resection combined with major laparoscopic liver resection. Results: The surgical approach was total laparoscopic (25 patients) or a hybrid technique (1 patients). The incision created for the extraction of the specimen varied between 5 and 8cm. The median operation time was 245 (range 150-320) minutes with a total blood loss of 600 (range 200-750) ml. The average postoperative hospital stay was 7 days (5-12). An R0 resection was achieved in all patients. The conversion rate was 3.8% (1 patient), because we did not find metastases. The complication rate was 3.8% too, 1 patient was with a low-debit biliary fistula (grade B).Conclusions: Simultaneous laparoscopic colorectal and liver resection appears to be safe and feasible in selected patients with CRC and SLM, with satisfying short-term results.