Simultaneous Single-Incision Laparoscopic Anterior Resection and Hepatic Metastasectomy in Colorectal Cancer

Abstract

Purpose: The single-incision laparoscopic colectomy has recently been reported for the surgical treatment of the colorectal cancer1. However, to this date, there have been only a few reports on a single-incision laparoscopic liver resection and no reports that we know of on a simultaneous colon resection with a hepatic metastasectomy2,3. We present our experience with a single-incision laparoscopic anterior resection and a simultaneous hepatic metastasectomy. Methods: The patient was a 67-year-old female with a body mass index of 26.2 kg/m2. Pre-operative studies showed an adenocarcinoma located in the sigmoid colon and a 1-cm-size mass in liver segment 4, which was suspected of being a metastatic lesion. A 2-cm vertical trans-umbilical skin incision was made, and a three-port access system was used. The inferior mesenteric pedicle was ligated, and the recto-sigmoid colon was resected. An end-to-end colorectal anastomosis was successfully made using a circular stapler. After the anterior resection of the sigmoid colon cancer, a liver resection was performed while exercising caution to maintain an appropriate resection margin and a meticulous hemostasis. Intra-operative laparoscopic ultrasound was used for an accurate localization of the metastatic lesion before the resection. Results: The operative time was 250 minutes. Most procedures did not differ much from the conventional laparoscopic surgery and were possible with the usual laparoscopic instruments. No adverse event occurred during the operation. Struggling between the instruments could be minimized by using a 5-mm-long rigid laparoscope (45° direction-of-view camera, 45-cm length) and articulating instruments. Pathologic examination showed a T2N1M1 adenocarcinoma (1 metastatic lymph node out of 25 harvested nodes, an 8×6×5 mm3 metastatic nodule in S4) with clear resection margins. During the 16-month follow-up since the treatment, no recurrence has been detected. Conclusion: Based on our current result, we successfully performed the operation on our patient while maintaining an oncologic safety. To date, to the best of our knowledge, this is the first report on a simultaneous resection for a primary colon cancer and a synchronous liver metastasis using a single-port laparoscopic system. No competing financial interests exist. Runtime of video: 7 mins