Chie Takasu, MD, Mitsuo Shimada, Nobuhiro Kurita, Takashi Iwata, Hirihiko Sato, Masanori Nishioka, Shinya Morimoto, Kozo Yoshikawa, Tomohiko Miyatani, Masakazu Goto, Hideya Kashihara, Tohru Utsunomiya. Department of Surgery, The University of Tokushima
Approximately 20%-25% of patients with colorectal cancer have synchronous liver metastasis at the time of diagnosis. The optimal strategy for resectable synchronous colorectal liver metastases remains controversial. Simultaneous resection of primary colorectal cancer and metastatic liver tumor is the treatment option, but there is still few reports about laparoscopic simultaneous resection. The aim of this study was to evaluate whether laparoscopic colorectal resection with simultaneous resection of synchronous liver metastases was technically feasible and safe.
We evaluated the 73 patients undergoing surgery from 2004 to 2010. Patients were divided into 3 groups, laparoscopic hepatectomy (A group) (n=43), stimultaneous laparoscopic resection of primary colorectal cancer and metastatic liver tumor (B group) (n=6), simultaneous open resection of primary colorectal cancer and metastatic liver tumor (C group) (n=24). A comparison was made to the groups with regard to clinicopathological and perioperative and postoperative factors.
The difference was not admitted in the age, sex, body-mass index, chronic disease. The mean operating time was A: B: C= 265(184-411): 508(430-591): 471(190-764) minutes. Group A was significantly shorter (p<0.05) and there was no difference between group B and C. The mean blood loss was A: B: C= 183(10-590): 165(10-259): 440(85-820) ml. Group C had significantly higher volume than other two groups (p<0.05).
There was no surgical mortality, but only one case in A group was converted to open surgery. And postoperative complication rate was significantly higher in C group, A: B: C= 11:16:33%. The most common complication is bile leakage (three cases), and second was bowel obstruction, wound infection and milky fluid (two cases, each). In B group, there were no postoperative complications except for one patient with subcutaneous hemorrhage and melena because of the antiplatelet agent.
The mean postoperative hospital stay was A: B: C= 16 (7-46): 26(17-43): 34(17-119) day. Group A was significantly shorter (p<0.05), but there was no difference between group B and C.
This study shows that simultaneous laparoscopic resection of primary colorectal cancer and liver metastasis is technically feasible and safe and efficiency in selected patients.
Session Number: Poster – Poster Presentations
Program Number: P037