Two cases of laparoscopic-assisted simultaneous resection of colorectal cancer and synchronous liver metastases in elderly patients

Tomoaki Ito, Tomoyuki Kushida, Mutsumi Sakurada, Hiroshi Maekawa, Hajime Orita, Koji Senuma, Konomi Mizuguchi, Koichi Sato. Department of Surgery, Juntendo University Shizuoka Hospital

The liver is the most common site of colorectal metastases. Laparoscopic resection for colorectal cancer and laparoscopic liver surgery have been widely recognized as safe. In 2015, it has been reported that in multi experienced centers, laparoscopic simultaneous resection of colorectal primary tumor and liver metastases is technically feasible and safe. However, the feasibility of simultaneous laparoscopic procedures for colorectal cancer and synchronous colorectal liver metastases in the elderly patients has not been studied sufficiently.

In this study, two cases of laparoscopic-assisted simultaneous resection of colorectal cancer and synchronous liver metastases in elderly patients are reported. An 83-year-old woman with right hypochondrial pain was diagnosed with ascending colon cancer and synchronous hepatic metastases in the left lobe of the liver (segments 2/3) measuring 45mm and the right lobe of the liver (segment 6) measuring 17mm. She had a history of bronchial asthma. Performance status (PS) was 0. Body mass index (BMI) was 23.6. Laparoscopic-assisted simultaneous resection of colon primary and liver metastases were performed. Afterwords, laparoscopic ultrasonography was performed. The presence of a hepatic metastasis at the right lobe of the liver (segment 7) measuring 5mm was also revealed. Hand-assisted radiofrequency ablation (RFA) was performed because of a tiny tumor and a difficulty of laparoscopic approach. The operative time was totally 470 minutes. The intraoperative blood loss was 340 grams. The patient’s disease was staged as IV (pT4apN2apM1a) according to the TNM classification. The postoperative course was uneventful and the postoperative stay was 23 days.

The other case involved a 78-year-old man with anemia who was diagnosed with ascending colon cancer and synchronous hepatic metastasis in the right lobe of the liver (segment 6) measuring 10mm. He had bronchial asthma, hypertension and hyperlipidemia as comorbidities. His PS was 0 and BMI was 26.4. Laparoscopic-assisted simultaneous resection of colon primary resection and liver metastasis were performed. The total operative time was 471 minutes. The intraoperative blood loss was 240 grams. The patient’s disease was staged as IV (pT3pN0pM1a) according to the TNM classification. The postoperative course was uneventful and the postoperative stay was 17 days. Our results may indicate that laparoscopic-assisted simultaneous resection of colorectal cancer and synchronous liver metastases in elderly patients is feasible and safe. However, further studies with large numbers of patients are needed to establish guidelines for surgical procedures who undergo laparoscopic-assisted simultaneous resection of colorectal cancer and synchronous liver metastases.

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