Takeaki Ishizawa, MD, PhD, FACS1, Shoji Kawakatsu2, Yoshiya Fujimoto2, Takafumi Sato2, Yoshihiro Ono2, Yoshihiro Mise2, Yosuke Inoue2, Hiromichi Ito2, Yu Takahashi2, Masashi Ueno2, Akio Saiura2. 1Cancer Institute Hospital / The University of Tokyo, 2Cancer Institute Hospital, Japanese Foundation for Cancer Research
Background: Although laparoscopic approach has been indicated widely in treatment of colorectal cancer with synchronous liver metastasis, safety and efficacy of laparoscopic simultaneous hepatectomy remains unclear.
Methods: Subject consisted of 258 patients who had undergone curative resection of colorectal cancer with simultaneous hepatectomy for synchronous liver metastasis. Surgical outcomes were compared between patients in the early period (2006-2012, n=117) and those in the latter period (2013-2017, n=141). In the latter period, short-term outcomes were also compared between the open hepatectomy group (OH; open or laparoscopic colorectal resection with open hepatectomy) and the laparoscopic hepatectomy group (LH; laparoscopic colorectal resection with laparoscopic hepatectomy). Laparoscopic hepatectomy has been indicated as a standard care since 2013, basically for liver metastasis resected by 4 or less wedge resections and/or left lateral sectionectomy.
Results: Indication of laparoscopic surgery had been extended over time; proportion of open hepatectomy and colorectal resection, open hepatectomy and laparoscopic colorectal resection, and laparoscopic hepatectomy and colorectal resection was 50%, 45%, and 5% in the early period and 21%, 53%, and 26% in the latter period, respectively. In the latter period, length of postoperative hospital was shorter than the early period (median [range], 15 [6-71] days vs. 17 [7-84)] days; P=0.041), while total operation time tended to be prolonged (519 [248-998] min vs. 425 [173-1116] min; P<0.001). In the latter period, surgical outcomes in the LH group (n=37) were more favorable than those in the OH group (n=104) in terms of total operation time (474 [311-905] min vs. 548 [248-998] min; P=0.025), estimated blood loss amount (200 [5-700] mL vs. 580 (0-1675) mL, P<0.001), postoperative hospital stay (13 [8-42] days vs. 15 [8-71] days; P=0.004), and R0 rate for liver metastasis (100% vs. 89%; P=0.008), although hepatic transection speed in the LH group was slower (0.61 [0.14-1.18] cm2/s vs. 1.36 [0.34-4.7] cm2/s). Morbidity and mortality were 5.4% and 0% in the LH group and 9.6% and 0% in the OH group, respectively.
Conclusion: Laparoscopic simultaneous hepatectomy with colorectal resection can be applied safely and may enhance patients’ postoperative recovery, if liver metastasis can be removed by simple wedge resections and/or left lateral sectionectomy. Further improvement in hepatic transection techniques is needed to extend indication of totally laparoscopic approach to colorectal cancer with synchronous metastasis requiring complicated hepatectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94339
Program Number: P650
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster