Surgical Strategy for Synchronous Colorectal Neoplasia: Lparoscopica Resection is Feasible

Abstract

Background/Aims. New diagnostic technologies have led to a greater chance of preoperative detection of synchronous neoplasms in patients undergoing surgical resection of colorectal tumors. Although synchronous colorectal neoplasia (SCRN) has been known for years, clinical signs and symptoms, optimal diagnostic methods and treatment strategy, and prognosis remain unclear. The benefits of laparoscopic colon resection have been widely reported, and several reports of laparoscopic resection in cases of SCRN have also been published. However, larger series will be needed to verify the advantage of laparoscopic resection for patients with SCRN. Methods. Among 1,023 retrospectively identified patients who underwent laparoscopic colon resection for colorectal cancer at our institution between 2004 and 2012, 32 (3.1%) had multiple primary colorectal neoplasms. There was at least one malignant tumor in all 32 cases, and 19 patients had two malignant tumors. In patients with synchronous adenomas who were not candidates for endoscopic mucosal resection or submucosal dissection of the benign lesions, benign and malignant lesions were resected simultaneously during laparoscopic colectomy. Results. Twenty-one of the 32 patients had stage I or II tumors and 11 had stage III or IV tumors. The mean index tumor size was 4.4 cm, and the most frequent locations were the right colon and the rectum. Secondary tumors were evenly distributed in all locations. The mean operation time was 309 minutes, and blood loss was approximately 250 mL. Among surgical strategies, double anastomosis was performed in 12 patients, a permanent stoma was created in 3 patients, and 5 patients had a temporary stoma. In terms of immediate outcomes, time to flatus was 4 days and hospital stay was 14 days. Six patients had postoperative complications but there was no surgical mortality. Conclusion. Laparoscopic surgery had acceptable short-term outcomes in patients with SCRN. The main advantages of laparoscopic surgery are smaller incisions and reduced postoperative pain. Despite longer operation times due to the extended dissection field, laparoscopic surgery was a feasible surgical strategy for patients with SCRN.