Laparoscopy for metastatic colorectal cancer

Laparoscopic combined colorectal and liver resections for primary colorectal cancer with synchronous liver metastases

BACKGROUNDS/AIMS

Synchronous liver metastases (SLMs) are found in 15-25% of patients at the time of diagnosis with colorectal cancer, which is limited to the liver in 30% of patients. Surgical resection is the most effective and potentially curative therapy for metastatic colorectal carcinoma (CRC) of the liver. The comparison of simultaneous resection of primary CRC and synchronous liver metastases with staged resections is the subject of debate with respect to morbidity. Laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens hospitalization, and yields superior cosmetic results, without compromising the oncological outcome. The aim of this study is therefore to evaluate our initial experience with simultaneous laparoscopic resection of primary CRC and SLM.

METHODS

Currently, laparoscopic resection of primary CRC is performed in more than 53% of all patients in our surgical department. Twenty-six patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. Six of them underwent laparoscopic colorectal resection combined with major laparoscopic liver resection.

RESULTS

The surgical approaches were total laparoscopic (25 patients) or hybrid technique (1 patients). The incision created for the extraction of the specimen varied between 5 and 8cm. The median operation time was 223 minutes (100 to 415 min.) with a total blood loss of 180 ml (100-300 ml). Postoperative hospital stay was 6.8 days (6-14 days). Postoperative complications were observed in 6 patients (22.2%).

CONCLUSIONS

Simultaneous laparoscopic colorectal and liver resection appears to be safe, feasible, and with satisfying short-term results in selected patients with CRC and SLM.

Laparoscopic anterior approach of major hepatectomy combined with colorectal resection for synchronous colorectal liver metastases

PURPOSE

The aim of the study was to evaluate the feasibility and operative outcomes of the anterior approach technique for a simultaneous colorectal and liver laparoscopic procedure given its demonstrated benefits and discuss the advantages of this strategy.

PATIENT AND METHODS

In the presented case, a total laparoscopic anterior approach was used for a left hemihepatectomy in combination with laparoscopic colorectal resections for synchronous liver metastases, which emphasizes the technical aspects of this procedure. The duration of surgery, blood loss, and postoperative outcomes were evaluated.

RESULTS

The laparoscopic anterior approach for a left hepatectomy with simultaneous colon resection for liver metastases was feasible and safe without postoperative complications. The duration of surgery was 190 minutes with an estimated blood loss of 200 mL. The postoperative course was uneventful.

CONCLUSIONS

The laparoscopic anterior approach for a major hepatectomy for unilobular synchronous metastases can be safely performed simultaneously with colorectal surgery in select patients.

Palliative resection of the primary tumour in patients with Stage IV colorectal cancer: systematic review and meta-analysis of the early outcome after laparoscopic and open colectomy

AIM

Resection of the primary tumour in patients with Stage IV colorectal cancer may be performed to avoid future tumour-related complications whilst on systemic treatment. We compared the safety and efficacy of laparoscopic and open colectomy in this patient group.

METHOD

PubMed, MEDLINE and the Cochrane Library were searched in the English literature for studies between January 2000 and October 2012 dealing with laparoscopic resection of the primary tumour in Stage IV disease. Single-arm laparoscopic studies were systematically reviewed. Prospective and retrospective studies were included for meta-analysis. End-points include safety, complications, mortality and cancer specific outcome including 5-year and median survival.

RESULTS

Eleven studies comprising 1165 patients undergoing palliative laparoscopic colectomy for Stage IV colorectal cancer were included. Five studies were comparative studies of laparoscopic and open colectomy. The former took longer (pooled mean difference (MD) = 41.52, 95% CI = 11.47-71.56, Z = 2.71, P = 0.007), but resulted in a shorter length of stay (pooled MD = -2.41, 95% CI = -3.84 to -0.99, Z = 3.32, P = 0.0009), with fewer postoperative complications (pooled odds ratio = 0.53, 95% CI = 0.32-0.87, Z = 2.51, P = 0.01) and lower estimated blood loss (pooled MD = -47.71, 95% CI = -80.00 to -15.42, Z = 2.90, P = 0.004). Median survival ranged between 11.4 and 30.1 months.

CONCLUSION

Palliative colectomy performed laparoscopically is associated with a better perioperative outcome than open colectomy. Survival is dependent on the response to systemic chemotherapy.

Laparoscopic major hepatectomy can be safely performed with colorectal surgery for synchronous colorectal liver metastasis

BACKGROUND

The optimal strategy for resectable synchronous colorectal liver metastases remains controversial. Although some authors advocate a staged treatment, an increasing number of studies have reported that combined colorectal and liver resection is safe. Laparoscopic combined resection in primary colorectal cancer with synchronous liver metastases has been reported but there are no specific data for major liver resections. In the present study, we evaluated the feasibility of a simultaneous entirely laparoscopic procedure, in the light of the benefits of laparoscopy in both colon and liver surgery, and discussed the benefits of this strategy.

METHODS

Two cases are presented of totally laparoscopic major liver resections associated with laparoscopic colorectal resections for synchronous liver metastases with the emphasis on the technical aspects. Duration of surgery, blood loss and post-operative outcome were evaluated.

RESULTS

  Laparoscopic right hepatectomy or left hepatectomy with simultaneous colon resection for liver metastasis was feasible and safe with only one suprapubic 5-mm trocar added to the usual trocar sites. The mean duration of surgery was 327 min with a mean estimated blood loss of 200 ml. The post-operative course was uneventful.

DISCUSSION

In selected patients, laparoscopic major hepatectomies for unilobular synchronous metastases can be safely performed simultaneously with colorectal surgery.