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. 1. Introduction 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]. Surgical resection is the most effective and potential curative therapy for metastatic CRC to the liver. The treatment strategies and outcomes for these patients have undergone many evolutionary changes [4–6]. Technical innovations in the field of surgery continue to evolve. Minimally 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]. Currently, 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]. However, the use of laparoscopy in liver surgery is still limited in The Netherlands [10]. There are several treatment options for CRC patients presenting with synchronous liver metastases (SLMs) depending on primary tumor location (rectum or colon) and extent of hepatic disease. Planning of perioperative
References
[1]
L. C. Cummings, J. D. Payes, and G. S. Cooper, “Survival after hepatic resection in metastatic colorectal cancer: a population-based study,” Cancer, vol. 109, no. 4, pp. 718–726, 2007.
[2]
R. T. Grundmann, P. Hermanek, S. Merkel et al., “Diagnosis and treatment of colorectal liver metastases—workflow,” Zentralblatt fur Chirurgie, vol. 133, no. 3, pp. 267–284, 2008.
[3]
B. Cady, D. O. Monson, and N. W. Swinton, “Survival of patients after colonic resection for carcinoma with simultaneous liver metastases,” Surgery Gynecology and Obstetrics, vol. 131, no. 4, pp. 697–700, 1970.
[4]
H. D. González and J. Figueras, “Practical questions in liver metastases of colorectal cancer: general principles of treatment,” HPB, vol. 9, no. 4, pp. 251–258, 2007.
[5]
M. Hebbar, F. R. Pruvot, O. Romano, J. P. Triboulet, and A. de Gramont, “Integration of neoadjuvant and adjuvant chemotherapy in patients with resectable liver metastases from colorectal cancer,” Cancer Treatment Reviews, vol. 35, no. 8, pp. 668–675, 2009.
[6]
A. D. Yang, A. Brouquet, and J. N. Vauthey, “Extending limits of resection for metastatic colorectal cancer: risk benefit ratio,” Journal of Surgical Oncology, vol. 102, no. 8, pp. 996–1001, 2010.
[7]
E. Kuhry, W. F. Schwenk, R. Gaupset, U. Romild, and H. J. Bonjer, “Long-term results of laparoscopic colorectal cancer resection,” Cochrane Database of Systematic Reviews, no. 2, article CD003432, 2008.
[8]
S. K. Reddy, A. Tsung, and D. A. Geller, “Laparoscopic liver resection,” World Journal of Surgery, vol. 35, pp. 1478–1486, 2011.
[9]
2012, http://www.dsca.nl.
[10]
J. H. Stoot, R. M. van Dam, O. R. Busch et al., “The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery: a multicentre pilot study,” HPB, vol. 11, no. 2, pp. 140–144, 2009.
[11]
J. G. Hillings？ and P. Wille-j？rgensen, “Staged or simultaneous resection of synchronous liver metastases from colorectal cancer—a systematic review,” Colorectal Disease, vol. 11, no. 1, pp. 3–10, 2009.
[12]
H. Inagaki, T. Kurokawa, T. Nonami, and J. Sakamoto, “Hand-assisted laparoscopic left lateral segmentectomy of the liver for hepatocellular carcinoma with cirrhosis,” Journal of Hepato-Biliary-Pancreatic Surgery, vol. 10, no. 4, pp. 295–298, 2003.
[13]
T. M. Geiger, Z. D. Tebb, E. Sato, B. W. Miedema, and Z. T. Awad, “Laparoscopic resection of colon cancer and synchronous liver metastasis,” Journal of Laparoendoscopic and Advanced Surgical Techniques A, vol. 16, no. 1, pp. 51–53, 2006.
[14]
K. L. Leung, J. F. Y. Lee, R. Y. C. Yiu, S. S. M. Ng, and J. C. M. Li, “Simultaneous laparoscopic resection of rectal cancer and liver metastasis,” Journal of Laparoendoscopic and Advanced Surgical Techniques A, vol. 16, no. 5, pp. 486–488, 2006.
[15]
E. Vibert, T. Perniceni, H. Levard, C. Denet, N. K. Shahri, and B. Gayet, “Laparoscopic liver resection,” British Journal of Surgery, vol. 93, no. 1, pp. 67–72, 2006.
[16]
W. L. Law, J. K. M. Fan, J. T. C. Poon, H. K. Choi, and O. S. H. Lo, “Laparoscopic bowel resection in the setting of metastatic colorectal cancer,” Annals of Surgical Oncology, vol. 15, no. 5, pp. 1424–1428, 2008.
[17]
S. H. Kim, S. B. Lim, Y. H. Ha et al., “Laparoscopic-assisted combined colon and liver resection for primary colorectal cancer with synchronous liver metastases: initial experience,” World Journal of Surgery, vol. 32, no. 12, pp. 2701–2706, 2008.
[18]
P. Pessaux and F. Panaro, “Advantages of the first-step totally laparoscopic approach in 2-staged hepatectomy for colorectal synchronous liver metastasis,” Surgery, vol. 145, no. 4, p. 453, 2009.
[19]
F. Bretagnol, C. Hatwell, O. Farges, A. Alves, J. Belghiti, and Y. Panis, “Benefit of laparoscopy for rectal resection in patients operated simultaneously for synchronous liver metastases: preliminary experience,” Surgery, vol. 144, no. 3, pp. 436–441, 2008.
[20]
A. Sasaki, H. Nitta, K. Otsuka, T. Takahara, S. Nishizuka, and G. Wakabayashi, “Ten-year experience of totally laparoscopic liwer resection in a single institution,” British Journal of Surgery, vol. 96, no. 3, pp. 274–279, 2009.
[21]
T. Akiyoshi, H. Kuroyanagi, A. Saiura et al., “Simultaneous resection of colorectal cancer and synchronous liver metastases: initial experience of laparoscopy for colorectal cancer resection,” Digestive Surgery, vol. 26, no. 6, pp. 471–475, 2009.
[22]
M. Casaccia, F. Famiglietti, E. Andorno, S. di Domenico, C. Ferrari, and U. Valente, “Simultaneous laparoscopic anterior resection and left hepatic lobectomy for stage IV rectal cancer,” Journal of the Society of Laparoendoscopic Surgeons, vol. 14, no. 3, pp. 414–417, 2010.
[23]
J. S. Lee, H. T. Hong, J. H. Kim et al., “Simultaneous laparoscopic resection of primary colorectal cancer and metastatic liver tumor: initial experience of single institute,” Journal of Laparoendoscopic and Advanced Surgical Techniques, vol. 20, no. 8, pp. 683–687, 2010.
[24]
M. Hayashi, K. Komeda, Y. Inoue et al., “Simultaneous laparoscopic resection of colorectal cancer and synchronous metastatic liver tumor,” International Surgery, vol. 96, no. 1, pp. 74–81, 2011.
[25]
H. Tranchart, P. S. Diop, P. Lainas et al., “Laparoscopic major hepatectomy can be safely performed with colorectal surgery for synchronous colorectal liver metastasis,” HPB, vol. 13, no. 1, pp. 46–50, 2011.
[26]
A. DeSouza, B. Domajnko, J. Park, S. Marecik, L. Prasad, and H. Abcarian, “Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy?” Surgical Endoscopy and other Interventional Techniques, vol. 25, no. 4, pp. 1031–1036, 2011.
[27]
A. Chiappa, A. P. Zbar, F. Biella, and C. Staudacher, “Survival after repeat hepatic resection for recurrent colorectal metastases,” Hepato-Gastroenterology, vol. 46, no. 26, pp. 1065–1070, 1999.
[28]
M. C. de Jong, S. C. Mayo, C. Pulitano et al., “Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: results from an international multi-institutional analysis,” Journal of Gastrointestinal Surgery, vol. 13, no. 12, pp. 2141–2151, 2009.
[29]
C. W. Pinson, J. K. Wright, W. C. Chapman, C. L. Garrard, T. K. Blair, and J. L. Sawyers, “Repeat hepatic surgery for colorectal cancer metastasis to the liver,” Annals of Surgery, vol. 223, no. 6, pp. 765–776, 1996.
[30]
A. Laurent, C. Tayar, M. Andréoletti, J. Y. Lauzet, J. C. Merle, and D. Cherqui, “Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma,” Journal of Hepato-Biliary-Pancreatic Surgery, vol. 16, no. 3, pp. 310–314, 2009.
