Simultaneous Liver and Colorectal Resections Are Safe for Synchronous Colorectal Liver Metastases

Background

Hepatic resection (HR) is the only option offering a potential cure for patients with synchronous colorectal cancer liver metastases (SCRLM). The optimal timing of HR for SCRLM is still controversial. This study aimed to determine whether simultaneous HR is similar to staged resection regarding the morbidity and mortality rates in patients with SCRLM.

Methods

Four hundred and five consecutive patients with SCRLM were treated with either simultaneous (n?=?129) or staged (n?=?276) HR. The postoperative complications were analyzed retrospectively according to the documented records and hepatectomy databases at the Gastrointestinal Institute.

Results

Perioperative morbidity and mortality did not differ between simultaneous resections and staged resections for selected patients with SCRLM (morbidity, 47.3% versus 54.3%; mortality, 1.5% versus 2.0%, respectively; both p?>?0.05). Simultaneous liver resections of three or more segments would not increase the rate of complications compared to staged resections (56.8% and 42.4%, respectively; p?=?0.119). Meanwhile, patients with simultaneous resections experienced shorter duration of surgery and postoperative hospitalization time as well as less blood loss during surgery (all p?<?0.05).

Conclusions

Simultaneous resections of colorectal cancer primary lesions and hepatic metastases were safe and could serve as a primary option for selected SCRLM patients.     

Short-Term Outcomes of Simultaneous Laparoscopic Colectomy and Hepatectomy for Primary Colorectal Cancer With Synchronous Liver Metastases

Although simultaneous resection of primary colorectal cancer and synchronous liver metastases is reported to be safe and effective, the feasibility of a laparoscopic approach remains controversial. This study evaluated the safety, feasibility, and short-term outcomes of simultaneous laparoscopic surgery for primary colorectal cancer with synchronous liver metastases. From September 2008 to December 2013, 10 patients underwent simultaneous laparoscopic resection of primary colorectal cancer and synchronous liver metastases with curative intent at our institute. The median operative time was 452 minutes, and the median estimated blood loss was 245 mL. Median times to discharge from the hospital and adjuvant chemotherapy were 13.5 and 44 postoperative days, respectively. Negative resection margins were achieved in all cases, with no postoperative mortality or major morbidity. Simultaneous laparoscopic colectomy and hepatectomy for primary colorectal cancer with synchronous liver metastases appears feasible with low morbidity and favorable outcomes.Key words: Simultaneous laparoscopic hepatectomy and colectomy, Primary colorectal cancer with synchronous liver metastases, Short-term outcomeColorectal cancer (CRC) is a leading cause of cancer-related death globally, and 14.5% of CRC patients have synchronous liver metastases that are identified during the diagnostic workup or during the course of treatment.¹ Surgical resection of the primary CRC and synchronous colorectal liver metastases (SCRLM) is warranted because this strategy offers the most effective therapy and is potentially curative. However, the optimal treatment schedule and strategy for treating CRC with SCRLM with surgery and chemotherapy remains unclear. Several reports have shown the benefit of simultaneous open resection of primary CRC and SCRLM versus a staged approach.²⁻⁴ In addition, recent improvements in laparoscopic surgery for CRC and liver cancer make this option attractive, and there are several reports of simultaneous laparoscopic colectomy and hepatectomy in the literature.⁵⁻¹⁴ In spite of these promising developments, though, the feasibility of these procedures has been controversial in terms of efficacy, safety, and outcome. The aim of this study was to evaluate the short-term operative and oncologic outcomes of simultaneous laparoscopic colectomy and hepatectomy for patients with primary CRC and SCRLM.     

Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Multi-institutional Analysis

Background The safety of simultaneous resections of colorectal cancer and synchronous liver metastases (SCRLM) is not established. This multi-institutional retrospective study compared postoperative outcomes after simultaneous and staged colorectal and hepatic resections. Methods Clinicopathologic data, treatments, and postoperative outcomes from patients who underwent simultaneous or staged colorectal and hepatic resections at three hepatobiliary centers from 1985–2006 were reviewed. Results 610 patients underwent simultaneous (n = 135) or staged (n = 475) resections of colorectal cancer and SCRLM. Seventy staged patients underwent colorectal and hepatic resections at the same institution. Simultaneous patients had fewer (median 1 versus 2) and smaller (median 2.5 versus 3.5 cm) metastases and less often underwent major (≥ three segments) hepatectomy (26.7% versus 61.3%, p < 0.05). Combined hospital stay was lower after simultaneous resections (median 8.5 versus 14 days, p < 0.0001). Mortality (1.0% versus 0.5%) and severe morbidity (14.1% versus 12.5%) were similar after simultaneous colorectal resection and minor hepatectomy compared with isolated minor hepatectomy (both p > 0.05). For major hepatectomy, simultaneous colorectal resection increased mortality (8.3% versus 1.4%, p < 0.05) and severe morbidity (36.1% versus 15.1%, p < 0.05). Combined severe morbidity after staged resections was lower compared to simultaneous resections (36.1% versus 17.6%, p = 0.05) for major hepatectomy but similar for minor hepatectomy (14.1% versus 10.5%, p > 0.05). Major hepatectomy independently predicted severe morbidity after simultaneous resections [hazard ratio (HR) = 3.4, p = 0.008]. Conclusions Simultaneous colorectal and minor hepatic resections are safe and should be performed for most patients with SCRLM. Due to increased risk of severe morbidity, caution should be exercised before performing simultaneous colorectal and major hepatic resections.     

Simultaneous resection for colorectal cancer and synchronous liver metastases

Purposes

The correct timing of hepatectomy in patients with synchronous colorectal liver metastases is unclear. The aim of this study was to assess the clinical value of simultaneous resection (SR) for patients with colorectal cancer and synchronous liver metastases.

Methods

Between January 2006 and December 2013, 158 patients underwent resection of primary colorectal cancer and liver metastases. Sixty-three patients possessed synchronous colorectal liver metastases. Of those with synchronous colorectal liver metastases, 41 patients (65 %) underwent SR, and 22 (35 %) underwent delayed resection (DR). The clinicopathologic and operative data and the surgical outcomes of the patients in the SR and DR groups were retrospectively analyzed.

Results

The type of primary/liver resection, liver resection time, total blood loss volume, R0 resection rate, and morbidity rate were similar between the two groups. The SR group was associated with a shorter total postoperative hospital stay (21 vs 32 days, p < 0.001). However, the overall survival rate was similar between the two groups (3-year survival, 65.6 % in the SR group versus 66.8 % in the DR group, p = 0.054).

Conclusion

Simultaneous resection of colorectal cancer and synchronous liver metastases is associated with a comparable morbidity rate and shorter hospital stay, even when following rectal resection and major hepatectomy.

     

Laparoscopic resection of primary midgut carcinoid tumors

Background

Laparoscopic intestinal surgery is the preferable technique for the majority of intestinal surgical disorders. However, no series on laparoscopic resection of intestinal midgut carcinoid tumors (MCTs) has been reported to date. This is related to the rarity of these tumors as well as the technical difficulties resecting the large mesenteric root lymph node mass commonly found with these tumors and the occasional difficulty identifying the primary MCT, which may be small and undetected on preoperative imaging studies. This is the first series to report the results for laparoscopic resection of MCT.

Methods

All consecutive patients with MCT (excluding appendiceal carcinoid tumor) between 2002 and 2012 underwent laparoscopic resection. The patient’s clinical data, preoperative endocrine workup, imaging studies, operative data, final histology, and outcome were recorded and analyzed.

Results

During the study period, 35 patients underwent surgery for primary intestinal carcinoid tumor. Of the 35 patients, 20 (12 women and 8 men ages 26–86 years) had surgery for primary MCT, and the remainder had a colorectal carcinoid tumor. In the MCT group, ten patients had liver metastases at the time of surgery. In three patients, multiple synchronous MCTs were detected intraoperatively. All the patients underwent a laparoscopic resection with en bloc resection of the corresponding mesenteric root mass. No conversion to open surgery was needed, and no major morbidity occurred. Two patients (10 %) each experienced minor morbidity with wound infection and prolonged ileus. The median hospital length of stay was 6 days (range 4–9 days). During a follow-up period of 3–96 months, no patients experienced local or regional recurrence. No distant metastases were detected during the follow-up period in any patients who had surgery with intent to cure.

Conclusion

Although technically difficult, laparoscopic resection of primary MCTs is feasible and safe, with the additional known significant advantages of laparoscopic surgery in general. Similar to the large-scale prospective studies that proved the oncologic safety of laparoscopic surgery for colorectal cancer, this small series showed that the laparoscopic technique also may be oncologically safe for these rare tumors.     

Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study

Background/purpose  One-stage resection of primary colon cancer and synchronous liver metastases is considered an effective strategy of cure. A laparoscopic approach may represent a safe and advantageous choice for selected patients with the aim of improving the early outcome. Methods  Between January 2008 and October 2008, 7 patients underwent one-stage laparoscopic resection for primary colorectal cancer combined with laparoscopic or robot-assisted liver resection. Results  A total of five laparoscopic left-colon, one right-colon, and one rectal resections were performed. Three patients underwent preoperative left-colon stenting and two received neoadjuvant chemotherapy. The patient with rectal cancer underwent neoadjuvant radiotherapy. Liver procedures included one bisegmentectomy (segments 2, 3), 3 segmentectomies, 6 metastasectomies, and four laparoscopic ultrasound-guided radiofrequency ablations (LUG-RFAs). One patient with multiple liver metastases was managed by a two-stage hepatectomy partially conducted by a totally laparoscopic approach. The overall postoperative morbidity was null. The median hospital stay was 10 days (range 7–10 days). Conclusions  This pilot study suggests that laparoscopic one-stage colon and liver resection is feasible and safe. Robot assistance may facilitate liver resection, increasing the number of patients who may benefit from a minimally invasive operation.     

Ten‐year experience of totally laparoscopic liver resection in a single institution

Background:

Recent developments in liver surgery include the introduction of laparoscopic liver resection. The aim of the present study was to review a single institution's 10‐year experience of totally laparoscopic liver resection (TLLR).

Methods:

Between May 1997 and April 2008, 82 patients underwent TLLR for hepatocellular carcinoma (HCC) (37 patients), liver metastases (39) and benign liver lesions (six). Operations included 69 laparoscopic wedge resections, 11 laparoscopic left lateral sectionectomies and two thoracoscopic wedge resections. Nine patients underwent simultaneous laparoscopic resection of colorectal primary cancer and synchronous liver metastases.

Results:

Median operating time was 177 (range 70–430) min and blood loss 64 (range 1–917) ml. Median tumour size and surgical margin were 25 (range 15–85) and 6 (range 0–40) mm respectively. One procedure was converted to a laparoscopically assisted hepatectomy. Three patients developed complications. Median postoperative stay was 9 (range 3–37) days. The overall 5‐year survival rate after surgery for HCC and colorectal metastases was 53 and 64 per cent respectively.

Conclusion:

TLLR can be performed safely for a variety of primary and secondary liver tumours, and seems to offer at least short‐term benefits in selected patients. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.     

Outcome of laparoscopic colectomy for cancer in elderly patients

Background

Resection for colon cancer in the elderly is a major undertaking. However, data on the outcome and survival of elderly patients who underwent laparoscopic resection for colon cancer are limited. This study of patients older than 75 years compared outcome and survival between those who underwent laparoscopic resection and those who had open resection for colorectal cancer.

Methods

From 2000 to 2009, 434 patients ages 75 years and older who underwent elective resection for colon cancer were included in the study. Patients who had rectal cancer or had undergone emergency operations were excluded. Preoperative diagnosis was determined by colonoscopy, and computed tomography scan was performed for preoperative staging. Data on the patients’ demographics, operative details, pathology results, postoperative results, and survival were collected prospectively. The patients who underwent laparoscopic surgery were compared with those who had open surgery.

Results

The study included 434 patients (210 men) with a median age of 80 years (range 75–95 years). Of these 434 patients, 189 underwent laparoscopic resection. Nine patients (4.8 %) required conversion to open operation. The patients did not differ in terms of age, gender, incidence of medical comorbidities, or stage of disease. The median operating time was longer in the laparoscopic group, but the blood loss was significantly less. Laparoscopic resection was associated with a lower mortality rate and a shorter hospital stay (p < 0.05). The open resection group had significantly more cardiac complications (p < 0.05). The overall 5-year survival rates were similar between the patients who had laparoscopic resections and those who had open surgery.

Conclusions

For patients older than 75 years, laparoscopic resection of colon is associated with less intraoperative blood loss, a shorter hospital stay, fewer cardiac complication, and a lower mortality rate than open resection. Therefore, the authors recommend laparoscopic resection of colon cancer as the treatment of choice for elderly patients.     

完全腹腔镜治疗结肠癌伴同时性肝转移的临床疗效

目的：探讨腹腔镜下行结肠癌根治术与肝转移灶切除术的安全性及疗效。 方法：选择2009年3月―2011年4月收治的50例结肠癌同时性肝转移患者,其中25例患者行腹腔镜下结肠癌根治术及肝转移灶切除术（腹腔镜组）,另25例在传统开腹手术（开腹组）。比较两组患者的术中情况、术后恢复情况以及术后1、2、3年生存率。 结果：腹腔镜组的术中出血量、术后镇痛时间、排气时间、住院时间及并发症均明显少于开腹组（P<0.05）,但两组的手术时间差异无统计学意义（P>0.05）。两组患者术后1、2、3年生存率差异无统计学意义（均P>0.05）。 结论：完全腹腔镜治疗结肠癌伴同时性肝转移安全可行,与开腹手术疗效相同,同时具有创伤小、术后恢复快、并发症少等优点。     

Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis

BACKGROUND: The optimal surgical strategy for the treatment of synchronous resectable colorectal liver metastasis has not been defined. The aims of this study were to review our experience with synchronous colorectal metastasis and to define the safety of simultaneous versus staged resection of the colon and liver. STUDY DESIGN: From September 1984 through November 2001, 240 patients were treated surgically for primary adenocarcinoma of the large bowel and synchronous hepatic metastasis. Clinicopathologic, operative, and perioperative data were reviewed to evaluate selection criteria, operative methods, and perioperative outcomes. RESULTS: One hundred thirty-four patients underwent simultaneous resection of a colorectal primary and hepatic metastasis in a single operation (Group I), and 106 patients underwent staged operations (Group II). Simultaneous resections tend to be performed for right colon primaries (p < 0.001), smaller (p < 0.01) and fewer (p < 0.001) liver metastases, and less extensive liver resection (p < 0.001). Complications were less common in the simultaneous resection group, with 65 patients (49%) sustaining 142 complications, compared with 71 patients (67%) sustaining 197 complications for both hospitalizations in the staged resection group (p < 0.003). Patients having simultaneous resection required fewer days in the hospital (median 10 days versus 18 days, p = 0.001). Perioperative mortality was similar (simultaneous, n = 3; staged, n = 3). CONCLUSIONS: Simultaneous colon and liver resection is safe and efficient in the treatment of patients with colorectal cancer and synchronous liver metastasis. By avoiding a second laparotomy, the overall complication rate is reduced, with no change in operative mortality. Given its reduced morbidity, shorter treatment time, and similar cancer outcomes, simultaneous resection should be considered a safe option in patients with resectable synchronous colorectal metastasis.     

Endoscopic resection as the first-line treatment for early colorectal cancer: comparison with surgery

Introduction

Endoscopic resection has emerged as an alternative therapeutic option for selected cases of early colorectal cancer. However, even now, few data are available on the comparative effectiveness of endoscopic versus surgical resection of early colorectal cancer. The aim of our study was to compare the clinical outcomes in patients with early colorectal cancer who underwent endoscopic resection and those who underwent surgical resection.

Methods

292 early colorectal cancer lesions in 287 patients who were treated with either endoscopic resection or colorectal surgery (open or laparoscopic colorectal resection) between January 2005 and December 2010 were retrospectively analyzed. After excluding 54 deep submucosal lesions [and/or tumor budding (Grade 2 or 3)], a total of 168 lesions with mucosal/superficial submucosal invasion were treated by endoscopic resection, and 70 lesions with mucosal/superficial submucosal invasion were treated by colorectal surgery.

Results

In the endoscopic resection group, the en bloc resection rate and the complete resection rate were 91.1 and 91.1 %, respectively. In the colorectal surgery group, both the en bloc resection rate and the curative resection rate were 100 %. However, using Log rank test in Kaplan–Meier curve, no significant difference in recurrence rate (including metachronous cancer) during the median follow-up period of 37 months (range, 6–98 months) was observed between the two groups (p = 0.647). In addition, a similar morbidity rate was observed for endoscopic resection compared with surgery (5.4 vs. 5.7 %, p = 0.760). A significantly shorter hospital stay was observed in the endoscopic resection group than colorectal surgery group [median 2 days (range, 2–29) vs. median 10 days (range, 7–37), p < 0.001).

Conclusion

We suggest that endoscopic resection, being equally effective but less invasive than surgery, can be the first-line treatment for well selected early colorectal cancer.     

Outcomes of simultaneous and delayed resections of synchronous colorectal liver metastases

Background

The optimal strategy for the treatment of synchronous colorectal liver metastases has not been established yet. In this study, we present the outcomes and survival rates of the patients who underwent simultaneous or delayed resections.

Methods

We performed a retrospective analysis of liver resections in our institution between 1997 and 2006.

Results

Among the 89 patients presenting with synchronous colorectal liver metastases, 28 underwent simultaneous and 61 underwent delayed resection. Age, sex and localization of the primary tumour were similar in the 2 groups. Duration of surgery and hospital stay were longer in the simultaneous resection group, and blood loss was also greater in this group. However, these factors did not influence the frequency of complications, which did not differ between the groups. When we included data from initial colectomy, these differences were either not significant or in favour of synchronous resection. In the delayed resection group, colon resection was performed in different hospitals. The 1-, 3- and 5-year survival rates were 78%, 70% and 45%, respectively, in the simultaneous and 88%, 55% and 38%, respectively, in the delayed resection groups.

Conclusion

In select patients, the risk of simultaneous resection of synchronous colorectal liver metastases is comparable to delayed resection, and increases in blood loss and operating time associated with simultaneous resections do not have a negative influence on long-term outcome. Positive outcomes of simultaneous liver resections in our study could be a result of good patient selection or experience with oncological liver surgery.     

Laparoendoscopic single-site minor hepatectomy for liver tumors

Background

Laparoscopic liver surgery is gaining increasing acceptance worldwide, but its frontiers are constantly challenged. Laparoendoscopic single-site surgery (LESS) has been performed for various organs, but the feasibility of LESS hepatectomies has yet to be explored fully.

Methods

From May 2010 to March 2011, seven patients underwent LESS minor hepatectomies. Patient demographic, operative, and clinical data were reviewed.

Results

Five left lateral sectionectomies, one segment 3, and one segment 5 resection were performed. The median operative time was 142?min (range, 104–171?min), and the median blood loss was 200?ml (range, 100–450?ml). The median hospital stay was 3?days (range, 1–11?days). For all the patients, the indications for surgery were suspected malignant tumors, and the surgical resection margins were clear for every patient.

Conclusions

Laparoendoscopic single-site minor hepatectomy is a novel modification to traditional laparoscopic surgery. The method is safe and feasible without any compromise to oncologic safety for selected patients with hepatocellular carcinoma (HCC) and colorectal liver metastases that are peripheral and smaller than 5?cm in size.     

Colorectal Cancer with Synchronous Resectable Liver Metastases: Monocentric Management in a Hepatobiliary Referral Center Improves Survival Outcomes

Background

Management of patients with synchronous colorectal liver metastases (SCRLM) should be individually tailored. This study compares patients managed by hepatobiliary centers from diagnosis with those referred for liver resection (LR).

Methods

Between 1998 and 2010, a total of 284 patients with SCRLM underwent resection; 106 resectable patients (1–3 unilobar metastases, diameter <100 mm, liver-only disease) were divided into two groups: 66 managed from diagnosis (group A) and 40 referred for LR (group B).

Results

Group A contained a greater proportion of multiple metastases (55.0 vs. 34.8 %, P = 0.042). Group B always received colorectal surgery as up-front treatment (vs. 18.2 %, P < 0.0001). In group B, chemotherapy before LR was more common (72.5 vs. 33.3 %, P = 0.0001) and lasted longer (P = 0.010). More patients in group B exhibited disease progression before LR (17.5 vs. 3.0 %, P = 0.025). Group A underwent fewer surgical procedures (80.3 % simultaneous resection vs. 0 %, P < 0.00001), with similar short-term outcomes. After a median follow-up of 42.0 months, group A exhibited higher 5 year disease-free survival (DFS, 64.8 vs. 30.8 %, P = 0.005) and fewer extrahepatic recurrences (21.5 vs. 47.5 %, P = 0.005). The late-referral group (>6 months, n = 24) had shorter median overall survival (OS) and DFS than group A (49.1 and 25.3 months vs. not achieved and not achieved, P < 0.05). The early-referral group exhibited OS and DFS similar to group A. Multivariate analysis confirmed late referral as a negative predictive factor of OS and DFS.

Conclusions

Monocentric management of SCRLM in hepatobiliary centers is associated with shorter preoperative chemotherapy, better disease control, fewer surgical procedures (simultaneous resection), and, compared with late-referred patients, better survival.     

Laparoscopic-Assisted Combined Colon and Liver Resection for Primary Colorectal Cancer with Synchronous Liver Metastases: Initial Experience

BACKGROUND: Laparoscopic approaches have become increasingly used in selected patients with either colorectal or liver cancer. However, the feasibility of laparoscopic-assisted combined colon and liver resection in primary colorectal cancer with synchronous liver metastases remains unknown. The aim of the present study was to determine the feasibility of laparoscopic-assisted combined colon and liver resection for primary colorectal cancer with synchronous liver metastases. METHODS: Laparoscopic surgery involving intestinal anastomosis was performed for primary colorectal cancer. The liver was then mobilized with the assistance of a hand inserted through the upper midline incision. For minor resections, the parenchymal transection was performed laparoscopically. For major resection involving a hilar dissection, transection was performed according to the standard open techniques under direct vision through the incision. Resected specimens were retrieved directly through the midline incision. RESULTS: Ten patients with primary colorectal cancer and synchronous liver metastases underwent the above procedure between September 2006 and April 2007. Surgical procedures for colorectal cancer included 5 low anterior resections, 3 anterior resections, 1 right hemicolectomy, and 1 subtotal colectomy. Combined hepatic surgery included 6 major hepatectomies, 3 segmentectomies, and 1 tumorectomy. All procedures were successful, with no conversions to open surgery required. The median operation time was 439 min (range: 210-690 min), and the median estimated blood loss was 350 ml (range: 300-1,200 ml). There was no surgical mortality or major morbidity, except in one patient in whom postoperative bleeding at the site of para-aortic node dissection was promptly controlled. CONCLUSIONS: Laparoscopic-assisted combined colon and liver resection is a feasible and safe procedure for the treatment of primary colorectal cancer with synchronous liver metastases.     

Predictive Factors for Anastomotic Leakage after Simultaneous Resection of Synchronous Colorectal Liver Metastasis

Background  

The optimal surgical strategy for resectable, synchronous, colorectal liver metastases remains unclear. The objective of this study was to determine which patients could benefit from staged resections instead of simultaneous resection by identifying predictive factors for postoperative morbidity and anastomotic leakage after simultaneous resection of synchronous, colorectal liver metastases and the primary colorectal tumor.     

完全腹腔镜下直肠癌根治合并肝左叶转移癌规则左半肝

目的 总结腹腔镜下一期行直肠癌根治、前入路左半肝切除的适应症和手术技巧。方法 分析我院一例直肠癌合并左肝多发转移的患者采用腹腔镜下直肠癌根治、规则性左半肝切除术。结果 手术时间190 min,术中出血300ml,无明显手术并发症,切口一期愈合。术后14d给予化疗。术后随访5个月,无局部复发、远处转移、及切口处肿瘤种植发生。结论一期行腹腔镜直肠癌根治合并左半肝规则切除,局限在单叶的肝多发转移灶行规则肝切除是安全可行的。     

Laparoscopic Versus Open Multivisceral Resection for Primary Colorectal Cancer: Comparison of Perioperative Outcomes

Background

The role of laparoscopic surgery for locally advanced colorectal cancer invading or adhering to neighboring organs is controversial. This study evaluated the safety and feasibility of laparoscopic multivisceral resection for colorectal cancer.

Methods

This study included 126 patients who underwent multivisceral resection for primary colorectal cancer invading or adhering to neighboring organs or structures between July 2005 and November 2012 at our institution. Perioperative outcomes were compared between laparoscopic and open resections.

Results

Laparoscopic and open multivisceral resections were performed in 60 and 66 patients, respectively. Conversion to open surgery occurred in 6.7 % of patients. The median operative time was significantly longer (271 vs. 227 min), but the median blood loss was significantly less (40 vs. 205 mL), in the laparoscopic compared with the open group. The R0 resection rate of the primary tumor (95 vs. 98.5 %), number of lymph nodes harvested (18 vs. 18), and postoperative complications (28 vs. 24 %) were comparable between the groups. The median length of hospital stay was significantly shorter (13.5 vs. 18 days) in the laparoscopic compared with the open group.

Conclusions

Laparoscopic multivisceral resection for colorectal cancer invading or adhering to neighboring organs is safe and feasible in selected patients.     

Simultaneous laparoscopic resection of colorectal cancer and synchronous metastatic liver tumor

Laparoscopic colorectal resection has been applied to advanced colorectal cancer. Synchronous liver metastasis of colorectal cancer would be treated safely and effectively by simultaneous laparoscopic colorectal and hepatic resection. Seven patients with colorectal cancer and synchronous liver metastasis treated by simultaneous laparoscopic resection were analyzed retrospectively. Three patients received a hybrid operation using a small skin incision, 2 patients underwent hand-assisted laparoscopic surgery using a small incision produced for colonic anastomosis, and 2 patients were treated with pure laparoscopic resection. The mean total operation duration was 407 minutes, and mean blood loss was 207 mL. Negative surgical margins were achieved in all cases. Mean postoperative hospital stay was 16.4 days. No recurrence at the surgical margin was observed in the liver. For selected patients with synchronous liver metastasis of colorectal cancer, simultaneous laparoscopic resection is useful for minimizing operative invasiveness while maintaining safety and curability, with satisfying short- and long-term results.