Toshimasa Yatsuoka, MD, Hirohiko Sakamoto, MD, Yoichi Tanaka, MD, Yoji Nishimura, MD, Kiwamu Akagi, MD
Saitama Cancer Center
Synchronous multiple colon cancer is defined as 2 or more primary colorectal cancers identified in the same patient and at the same time. We present the synchronous multiple colon cancer treated by laparoscopic colectomy (LAC). The aim of our report is to illustrate the technical aspects of performing two concurrent laparoscopic colectomy with sequential anastomosis and to analyze the safety, feasibility and oncological outcomes of the surgical technique for multiple colon cancer.
METHODS AND PROCEDURES:
Between December 2000 and September 2011, thirty patients underwent colectomy for synchronous multiple colon cancer at our division. Five patients underwent laparoscopic surgery (LAC groups) and 25 patients were treated by conventional open colectomy (OS groups). The combination of tumor location was right colon (from cecum to transverse colon) and left colon cancer (from descending to sigmoid colon) in 19 patients and synchronous right colon and rectal cancers in 11 patients, respectively. Dukes Stages A, B, C, and D were 10, 6, 8, and 6 cases. Twenty-two patients were curatively operated by each procedure. We retrospectively reviewed the difference between two groups. All operations were completed by one Japanese board-certified colon and rectal surgeon. Operative notes including age, sex, body mass index (BMI) and American Society of Anesthesiologists score (ASA) and operative videotapes were reviewed. Demographic data, intraoperative parameters, postoperative outcomes, pathology reports and molecular profiles including MSI, hyper methylation of the MLH1 promoter and mutation of both KRAS and BRAF were assessed. Tumors were classified as high level of MSI (MSI-H), low level (MSI-L) or stable (MSS).
All cases of LAC procedures were successfully performed with standard laparoscopic instruments through a single umbilical incision. No significant intraoperative complications occurred and no patients required conversion to open surgery in LAC groups. Compared to the OS group operative time (OT) for the LAC group was longer but no statistically significant difference was observed (p _ 0.0772). Mean OT was 321 +/- 115 minutes in OS groups and 450 +/- 42mintes in LAC groups. Estimated blood loss (EBL) and postoperative surgical site infection (SSI) in LAC were statistically significant less in LAC group. Mean EBL was 58 +/- 46 minutes in OS and 383 +/- 315mintes in LAC (p _ 0.0350). All patients in LAC group recovered without issues. At this time no recurrence was identified in LAC groups while recurrence occurred in two patients for OS groups. Among 24 informative cases MSI-H tumor were detected in four cases (17%). Two of them were diagnosed as Lynch Syndrome and the others were identified as CIMP type colon cancers.
Minimal invasive treatment of colorectal cancer offers the opportunity to treat two different multiple colon lesions at the same time, with safe and oncological validity. Although technology in this field is advancing very rapidly, we must have great necessity to practice further surgical skills to decrease the operative time. The careful selection of appropriate patients for concurrent segmental resection should be considered, depending on the different mechanism in tumor development of colorectal cancer.
Session: Poster Presentation
Program Number: P029