Perioperative outcomes in laparoscopic multivisceral resection of primary colorectal cancer

Kazuhiro Sakamoto, Shunsuke Motegi, Yurika Makino, Shingo Kawano, Kazuhiro Takehara, Shinya Munakata, Koichiro Niwa, Shun Ishiyama, Kiichi Sugimoto, Hirohiko Kamiyama, Makoto Takahashi, Hiromitsu Komiyama, Yutaka Kojima, Michitoshi Goto, Atsushi Okuzawa, Yuichi Tomiki. Department of Coloproctological Surgery, Juntendo University, Tokyo, Japan

Introductions: Laparoscopic surgery for colorectal cancer has been widely performed as a surgical treatment option. However, the use of laparoscopic surgery for locally advanced colorectal cancer invading or adhering to adjacent organs or structures is controversial because of oncological and technical issues. The aim of this study was to evaluate the feasibility of laparoscopic multivisceral resection of colorectal cancer.

Method: Between January 2010 and May 2015, 34 patients underwent multivisceral resection of primary colorectal cancer invading or adhering to adjacent organs or structures. The tumors were located in the right colon (n = 10), left colon (n = 18), and rectum (n = 6). Of the patients, 17 were male and 17 were female, with a median age of 71 years (45–86 years).

Results: The distribution of the resected adjacent organs or structures was as follows: abdominal or pelvic lateral wall, n = 7; small bowel or colon and rectum, n = 7; vagina or uterus, n = 7; peritoneum, n = 5; bladder, n = 4; vessels, n = 3; and seminal vesicles and levator ani muscle, n = 1. One patient had two resected organs (the bladder and small bowel). Conversion to open surgery occurred in 6 patients (17.6%). Although intraoperative complications were observed in 3 patients, these complications were managed laparoscopically. Postoperative complications occurred in 4 patients (11.8%), which were classified as grade 2 according to the Clavien-Dindo classification system. Reoperation was not required. The mean operation time was 306 min (range, 252–556 min), and blood loss was 47 mL (10-450 ml). Pathological invasion to other organs (pT4b) was confirmed in 17 patients (50%). Four patients had residual pathological tumors, corresponding to an R0 resection rate of 88.2%. The pathological TNM classification was stage 2 in 14 patients, stage 3 in 11 patients, and stage 4 in 9 patients. The mean postoperative hospital stay was 11 days (range, 8–22 days).

Conclusions: For primary colorectal cancers, the use of laparoscopic multivisceral resection is feasible for carefully selecting patients and diagnosing the involvement of adjacent organs. Conversion to open surgery before multivisceral resection is an important procedure to avoid dissemination of cancer cells and local recurrence, if the tumor margin is unclear, or if massive adherence to adjacent organs or structures is observed laparoscopically.

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