Surgical Endoscopy

, Volume 26, Issue 9, pp 2571–2578

Totally laparoscopic strategies for the management of colorectal cancer with synchronous liver metastasis

  • Francesco M. Polignano
  • Aaron J. Quyn
  • Pandanaboyana Sanjay
  • Nikola A. Henderson
  • Iain S. Tait
Article

DOI: 10.1007/s00464-012-2235-2

Cite this article as:
Polignano, F.M., Quyn, A.J., Sanjay, P. et al. Surg Endosc (2012) 26: 2571. doi:10.1007/s00464-012-2235-2

Abstract

Introduction

Laparoscopy is an accepted treatment for colorectal cancer and liver metastases, but there is no consensus for its use in the management of synchronous liver metastases (SCRLM). The purpose of this study was to evaluate totally laparoscopic strategies in the management of colorectal cancer with synchronous liver metastases.

Methods

Patients presenting to Ninewells Hospital between July 2007 and August 2010, with adenocarcinoma of the colon and rectum with synchronous liver metastases were considered. Patients underwent simultaneous laparoscopic liver and colon cancer resection, a staged laparoscopic resection of SCRLM and colon cancer, or simultaneous colon resection and radiofrequency ablation (RFA) of SCRLM. Primary endpoints were in-hospital morbidity and mortality, total hospital stay, intraoperative blood loss, duration of surgery, and resection margin status.

Results

Twenty-eight patients presented with synchronous colorectal liver metastases. Thirteen patients underwent a simultaneous laparoscopic liver and colon resection (median operating time, 370 (range, 190–540) min; median hospital stay, 7 (range, 3–54) days), seven patients had a staged laparoscopic resection of SCRLM and primary colon cancer (median operating time, 530 (range, 360–980) min; median hospital stay 14, (range, 6–51) days), and eight patients underwent laparoscopic colon resection and RFA of SCRLM (median operating time, 310 (range, 240–425) min; median hospital stay, 8 (range, 6–13) days). There were no conversions to an open procedure. Overall in-hospital morbidity and mortality was 28 and 0 % respectively. An R0 resection margin was achieved in 91 % of the resection group. At a median follow-up of 26 (range, 18–55) months, 19 (90 %) patients remain disease-free.

Conclusions

Totally laparoscopic strategies for the radical treatment of stage IV colorectal cancer are feasible with low morbidity and favorable outcomes. A laparoscopic approach for the simultaneous management of SCRLM and primary colon cancer is associated with reduced surgical access trauma, postoperative morbidity, and hospital stay with no compromise in short-term oncological outcome.

Keywords

Colorectal cancerSynchronousMetastasisLaparoscopy

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Francesco M. Polignano
    • 1
  • Aaron J. Quyn
    • 1
  • Pandanaboyana Sanjay
    • 1
  • Nikola A. Henderson
    • 1
  • Iain S. Tait
    • 1
  1. 1.Department of Hepatobiliary and Advanced Laparoscopic SurgeryNinewells Hospital and Medical SchoolDundeeUK