Simultaneous Laparoscopic Resection of Colorectal Cancer and Synchronous Liver Metastases

Go Wakabayashi, MD PhD FACS, Takeshi Takahara, MD, Yasushi Hasegawa, MD PhD, Naoko Ito, MD, Masahiro Takahashi, MD PhD, Hiroyuki Nitta, MD PhD. Department of Surgery, Iwate Medical University School of Medicine


Simultaneous laparoscopic resection of colorectal cancer and synchronous liver metastases is feasible and safe. We present a case to describe laparoscopic-assisted right hemi-colectomy followed by pure laparoscopic anatomical liver resection (S5; segment 5) for multiple synchronous liver metastases.
Case presentation: A 47 y/o female patient with ascending colon cancer with synchronous liver metastases was referred to our institute for simultaneous laparoscopic resection of ascending colon and two liver metastases located in S5. Operative procedure: Laparoscopic-assisted right hemi-colectomy was first performed. Then, anatomical segmentectomy of S5 was performed by intra-hepatic Glissonian approach at the hilar plate. After parenchymal transection of Cantlie line, several Glissons into S5 were visualized and clipped, then divided. Parenchymal transection first started from the left margin of S5, then along the demarcation line, and finished at the right margin of S5.
Results: Operative time was 298 min and blood loss was 30 ml. The patient was discharged on the 10th post-operative day without having any complications. Between 2002 and 2010, we experienced 16 cases of simultaneous laparoscopic resection of colorectal cancer and synchronous liver metastases. Mean age was 59 y/o ranging from 35 to 76, and 7 were male and 9 were female. Primary tumors were located in colon for 7 and in rectum for 9. Liver resections were 8 for partial, 2 for segmentectomy, 2 for sectionectomy, and 4 for lobectomy. Median operative time was 360 min ranging from 196 to 570. Median blood loss was 163 ml ranging from 2 to 1550. Median hospital stay was 14 days ranging from 7 to 84. One patient developed bile leakage after the surgery but treated conservatively.


Session Number: SS19 – Videos: HPB (Hepatobiliary and Pancreas)
Program Number: V030

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