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.

     

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.     

Hepatic resection for colorectal metastases in the caudate lobe of the liver

Although hepatic resections for colorectal metastases have become established procedures, there is still only a small number of reports of hepatic resections for such metastases in the caudate lobe. From 1993 to 2001, seven patients underwent eight hepatic resections for colorectal metastases in the caudate lobe at our department. The patients were five men and two women, and their ages were from 53 to 73 years. The ratio of synchronous to metachronous liver metastases was 2:5. Solitary metastasis was observed in one patient. One patient with a metastasis in the Spiegel lobe and three patients with metastasis in the caudate process underwent partial resection of the site. The other patients underwent resection of the Spiegel lobe (two times), resection of the right-sided caudate lobe, and total caudate lobe resection. The mean (±SE) operative time was 315.9 ± 30.6min. Mean intraoperative blood loss was 1325.9 ± 421.1ml, and mean postoperative hospital stay was 21 ± 3.7 days. One patient, who underwent sigmoidectomy and hepatectomy as an emergency operation due to ileus, experienced wound infection. No patient died within 12 months after the surgery. Five patients were alive at 24 months, and three at 36 months. The outcome of these patients encourages us to continue performing hepatic resection for colorectal metastases in the caudate lobe, as it is assumed to be a safe and effective procedure.     

Outcome of laparoscopic major liver resection for colorectal metastases

Background

Minimally invasive liver resection (MILR) for colorectal liver metastases (CRLM) is gaining widespread acceptance. However, data are still lacking on the feasibility, long- and short-term outcomes of laparoscopic major hepatectomy (i.e., three or more liver segments).

Methods

Between October 2002 and December 2008, prospectively collected data of 117 patients who underwent major liver resection [97 open (OMLR) and 20 laparoscopic (LMLR) procedures] for CRLM were analyzed. Twenty patients in the LMLR group were matched with 20 patients of the OMLR based on 13 parameters. We compared the long- and short-term outcomes between these two groups.

Results

Median duration of surgery was 257.5 (range 75–360)?min in LMLR versus 232.5 (range 120–400)?min in OMLR (P?=?0.228). Median blood loss during surgery was 550?ml in each group (range 100–4,000 vs. 100–2,500?ml, P?=?0.884). There was no statistically significant difference in the rate of postoperative complications (both severity and location). Median magnitude of tumor-free resection margin was 7.5 versus 5.5?mm in the laparoscopy versus open group, respectively (P?=?0.651). Median disease-free survival (DFS) of the entire study population was 18.4?months [95% confidence interval (CI) 11.9–50.0?months]. Median overall survival (OS) was 50.7?months (95% CI 36.2?months to undetermined). The estimated DFS and OS rates at 1, 2, and 5?years were comparable in the two groups (P?=?0.637 and 0.872, respectively).

Conclusion

Laparoscopic MLR for selected CRLM is feasible and might result in comparable oncologic outcomes as in open liver resection.     

Simultaneous resection of colorectal primary tumour and synchronous liver metastases

BACKGROUND: The surgical strategy for treatment of synchronous colorectal liver metastases remains controversial. The outcome and overall survival of patients presenting with such metastases, treated either by simultaneous resection or by delayed resection, were evaluated. METHODS: From 1987 to 2000, 97 patients presented with synchronous colorectal liver metastases, of whom 35 (36 per cent) underwent a simultaneous resection and 62 patients (64 per cent) a delayed resection. Simultaneous resection was considered prospectively for patients with fewer than four unilobar metastases. RESULTS: Age, blood transfusion requirements, operating time, duration of inflow occlusion, hospital stay and mortality rate were similar in the two groups. The morbidity rate did not differ significantly (23 per cent after simultaneous resection and 32 per cent after delayed resection). The location of the primary tumour and extent of liver resection did not influence the morbidity rate significantly in the simultaneous resection group. The overall survival rate was 94, 45 and 21 per cent at 1, 3 and 5 years respectively after simultaneous resection, and 92, 45 and 22 per cent after delayed resection. CONCLUSION: In selected patients, simultaneous resection of the colorectal primary tumour and liver metastases does not increase mortality or morbidity rates compared with delayed resection, even if a left colectomy and/or a major hepatectomy are required.     

腹腔镜下结直肠癌及肝转移癌一期同时切除术的临床应用

目的：探讨腹腔镜下一期同时切除结直肠癌和肝转移癌的安全性及可行性。方法回顾性分析2011年1月至2013年10月期间在中山大学孙逸仙纪念医院完成的腹腔镜下结直肠癌和肝转移癌一期同时切除手术的11例患者的病例资料,对该术式的可行性（中转开腹率、手术时间及术中出血量）、安全性（术后并发症）及疗效（术后恢复、复发及生存情况）进行评估。结果全组11例患者手术均取得成功,无中转开腹病例。手术时间（284．6±28．8） min,术中出血量（322．7±75．4） ml,术后肛门排气时间（2．9±0．7） d,术后住院时间（12．3±1．9） d。全组患者术后未出现肠瘘、胆瘘、腹腔大出血、腹腔感染及肝功能衰竭等并发症。术后随访时间3～35月,除1例患者因肿瘤转移死亡外,其余病例未见肿瘤复发。结论对于经过选择的合适病例,腹腔镜下同时切除结直肠癌和肝转移癌是安全、可行的。     

结直肠癌伴同时性肝转移同期腹腔镜手术与开腹手术的比较

目的 比较同期腹腔镜和同期开腹手术治疗结直肠癌伴同时性肝转移（sCRLM）的短期临床结果,初步探讨同期微创手术的可行性、安全性。方法 回顾性收集2011年1月至2018年12月于温州医科大学附属第一医院接受同期手术切除原发灶和肝转移灶的sCRLM患者临床资料,分为腔镜组（23例）和开腹组（22例）,比较两组围手术期指标。结果 与开腹组相比,腹腔镜组手术时间明显延长（296 min vs 175 min,P=0.01）,而术中出血量（267 mL vs 283 mL,P=0.398）、术后肛门排气时间（4.1 d vs 4.8 d,P=0.204）、进食流质食物时间（5.3 d vs 5.5 d,P=0.599）、术后并发症发生率（60.9% vs 59.1%,P=0.9）以及腹腔引流管留置时间（12.3 d vs 12.5 d,P=0.834）均无统计学差异;术后住院时间（16.7 d vs 20.4 d,P=0.366）有缩短趋势。结论 sCRLM患者行同期腹腔镜手术安全、可行,可在筛选后的患者中应用。     

Simultaneous laparoscopic resection of rectal cancer and liver metastasis

Simultaneous resection of colorectal tumor and liver metastasis has been advocated because of the benefits of avoiding a second operation, reduced morbidity, shorter treatment time, and similar outcomes. We report a case of simultaneous laparoscopic resection. The operative time was 350 minutes and the estimated blood loss was 500 mL. The patient required parenteral analgesia for less than 48 hours. Flatus was passed on postoperative day 3, and a solid diet was resumed on postoperative day 5. He was fully mobile on postoperative day 4 and was discharged 3 days later. With the advance of laparoscopic technology and technique, simultaneous resection becomes an attractive option.     

同期肝切除治疗结直肠癌同时性肝转移

目的探讨结直肠癌同时性肝转移肝肠同期手术的疗效。方法回顾性分析1994年8月至2004年12月在我院行外科手术治疗的121例同时性结直肠癌肝转移患者的临床资料。结果在121例同时性结直肠癌肝转移患者中,99例行结直肠癌根治性切除术,剔除2例行原位肝移植患者后,同期肝切除组41例（A组）,对肝转移瘤行姑息外科治疗组56例（B组）,即转移瘤未能完全经手术切除者,A、B组患者性别、年龄、原发瘤部位、浸润深度、淋巴结转移等差异均无统计学意义,肝转移瘤数目（x^2=40.41,P＜0.05）、肝转移瘤分布（x^2=11.61,P＜0.05）差异有统计学意义;两组患者中位生存期分别为28.9个月、17.1个月,5年生存率分别为14％、0,其中A组患者中位无瘤生存期为19.5个月,1、3、5年生存率为93%、44%和14%。结论同期肝切除能为部分结直肠癌同时性肝转移患者提供治愈机会,对于合适的患者应力争行同期肝切除术。     

Combined resection of liver and lung metastases for colorectal cancer

This article evaluates the available evidence for the efficacy of combined liver and lung metastasectomy. In addition, selection criteria identifying patients most likely to benefit from this approach are discussed. Surgery offers the only possibility for prolonged survival and is occasionally curative.     

Liver resection for colorectal cancer: liver metastases in the aged

The purpose of this study was to determine the morbidity and mortality in elderly patients undergoing liver resections for metastatic colon cancer and compare them with those of a control group of younger patients. The charts of all patients undergoing liver resection for colon cancer were retrospectively reviewed. Patients less than 70 years of age (Group A) were compared with patients 70 years of age or older (Group B). Between 1971 and 1995, 167 liver resections were performed for metastatic colorectal cancer. Of these, 41 patients were in Group A and 126 patients were in Group B. The mean age of Group A was 74.5 years, and that of Group B was 57 years. American Society of Anesthesiologists (ASA) classification was similar for both groups (Groups A and B were 75.6% and 81.1% ASA class II, respectively). Anatomic resections were performed in 49 per cent and wedge resections in 51 per cent of patients in Group A, and 68 and 32 per cent in Group B, respectively. Estimated blood loss was slightly less for Group A (1575 vs 1973 cm3), as was operative time (4.0 vs 4.7 hours). In-hospital mortality rate was 7.3 per cent for Group A and 2.4 per cent for Group B. The major morbidity rates were 29 and 17.5 per cent, respectively. Intensive care unit care was necessary in 73 per cent (mean length of stay 3.9 days) for Group A and 62.6 per cent (mean length of stay 2.0 days) for Group B. The average length of hospitalization was 13.1 days for Group A and 16.6 days for Group B. The recurrence rates were similar for the two groups [56% (Group A) vs 66% (Group B)], but mean survival was longer for younger patients (22.9 vs 33.5 months). We conclude that liver resection for colorectal cancer liver metastases in properly selected patients older than 70 years of age can be performed with acceptable morbidity and mortality rates. The long-term survival for older patients is less than that for younger patients, but is still a significant length of time. Therefore, we conclude that age alone is not a contraindication to liver resection for colorectal cancer metastases in patients older than 70.     

腹腔镜联合同期开放手术与全开放手术治疗同时性结直肠癌肝转移临床对比研究

目的对比腹腔镜结直肠癌切除(LCS)联合同期开放肝转移灶切除术与同期全开放切除术(TOS)治疗同时性结直肠癌肝转移(sCRLM)的临床疗效,探讨LCS联合同期开放肝转移灶切除术的安全性、短期及中长期疗效。方法回顾性分析2010年1月至2019年3月于海军军医大学附属长海医院肛肠外科行同期切除的sCRLM病人的临床病理资料,其中84例病人行LCS联合同期开放肝转移灶切除术,108例病人行同期TOS,采用倾向得分匹配方法(PSM)对两类病人进行1∶1匹配,最终LCS组(LCS联合同期开放肝转移灶切除术)和TOS组(行同期TOS)两组分别纳入69例病人,对两组病人的临床结果进行对比分析。结果所有病人无90 d内死亡病例。LCS组无中转开放手术病例。LCS组与TOS组相比,术后进食流质时间缩短[(3.54±1.43)d vs.(4.74±1.29)d,t=-5.186 P<0.001],术后住院天数减少[(8.58±4.23)d vs.(13.33±5.21)d,t=-5.880 P<0.001],并发症发生率降低[14例(20.3%)vs.33例(47.8%),χ^2=11.648 P=0.01],术中出血量[(433.77±423.45)mL vs(.422.46±292.37)mL,t=0.182 P=0.855]及手术时间[(277.54±81.88)min vs(.265.80±82.56)min,t=0.839 P=0.403]差异无统计学意义。3年存活率差异无统计学意义(60.0%vs.54.7%,χ^2=1.979,P=0.160),术后无瘤存活率差异无统计学意义(χ^2=3.542,P=0.076)。结论LCS联合同期开放肝转移灶切除术用于治疗sCRLM安全可行,相比传统同期TOS,短期疗效更优,且不影响中长期肿瘤学预后。     

吲哚菁绿荧光显影技术辅助腹腔镜下结直肠癌肝转移切除的应用价值

目的探讨吲哚菁绿荧光显影技术辅助腹腔镜下结直肠癌肝转移切除的应用价值。方法采用回顾性分析湖南省人民医院肝胆微创外科和结直肠外科2018年7月至2019年12月实施的9例吲哚菁绿荧光显影技术辅助腹腔镜下结直肠癌肝转移切除的临床资料。结果 9例病人均在吲哚菁绿荧光显影技术辅助腹腔镜下完成手术,无中转开腹病人。平均手术时间为285 min(225³50 min);术中平均失血量为163 ml(50³20 ml),术中输血1例;手术后住院8¹8 d,平均12 d;术后所有病人均未发生严重并发症。随访5²2个月,中位随访时间13个月,其中1例病人术后肝转移瘤再发并再次予以手术切除。结论吲哚菁绿荧光显影技术辅助腹腔镜下结直肠癌肝转移瘤切除是安全和可行,近期疗效尚可,但尚需更多病例和更长随访时间进一步论证。     

结直肠癌肝转移根治性切除预后因素分析

目的 分析影响结直肠癌肝转移患者根治性手术切除预后的临床病理因素,探讨改善患者预后的方法.方法 收集2005年1月至201 1年12月江苏省苏北人民医院和复旦大学附属肿瘤医院收治的103例结直肠癌肝转移根治性切除患者的临床资料.采用Kaplan-Meier法计算生存率,用Log-rank法分析患者生存情况,对各种影响预后的因素分别进行单变量和多变量Cox回归分析.结果 103例患者均获随访,随访时间10～ 60个月,术后1、3、5年生存率分别为90％、49％、39％.单因素分析结果显示:肝转移灶数目、大小、分布、术前CEA水平、手术并发症、术后化疗是肝转移灶切除术后的影响因素(x2值分别为24.732、9.461、9.568、25.948、25.370、5.701,P＜0.05);多因素分析显示,肝转移灶数目、肝转移灶切除术前CEA水平、手术并发症是影响预后的独立因素(Wald=7.974、12.051、11.547,P＜0.05).结论 肝转移灶数目、肝转移灶切除术前CEA水平和手术并发症是影响结直肠癌肝转移患者预后的独立因素.适当扩大手术切除的适应证,加强对高危患者的随访和术后辅助化疗,可能改善肝转移患者的预后.     

Simultaneous detection of colorectal carcinoma liver and lung metastases does not warrant resection

BACKGROUND: The primary objective of this study was to determine an objective method for estimating the risk of mortality after burn trauma, and secondarily, to evaluate the relationship between gender and mortality, in the setting of a quantifiable inflammatory stimulus. Previously reported estimates of mortality risk after burn trauma may no longer be applicable, given the overall reduction in case-fatality rates after burn trauma. We expect that future advances in burn trauma research will require careful and ongoing quantification of mortality risk factors to measure the importance of newly identified factors and to determine the impact of new therapies. Conflicting clinical reports regarding the impact of gender on survival after sepsis and critical illness may in part, be from different study designs, patient samples, or failure to adequately control for additional factors contributing to the development ofsepsis and mortality. STUDY DESIGN: Data from the prospectively maintained burn registry for patients admitted to the Parkland Memorial Hospital burn unit between January 1, 1989 and December 31, 1998 were analyzed. Logistic regression was used to generate estimates of the probability of death in half of the study sample, and this model was validated on the second half of the sample. Risk factors evaluated for their relationship with mortality were: age, inhalation injury, burn size, body mass (weight), preexisting medical conditions, nonburn injuries, and gender. RESULTS: Of 4,927 patients, 5.3% died. The best model for estimating mortality included the percent of total body surface area burned; the percent of full-thickness burn size; the presence of an inhalation injury; age categories of: < 30 years, 30 to 59 years, > or = 60 years; and gender. The risk of death was approximately two-fold higher in women aged 30 to 59 years compared with men of the same age. CONCLUSIONS: We have provided a detailed method for estimating the risk of mortality after burn trauma, based on a large, contemporary cohort of patients. These estimates were validated on a second sample and proved to predict mortality accurately. We have identified an increased mortality risk in women of 30 to 59 years of age.