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Laparoscopic Approach for Primary Colorectal Cancer Improves Outcome of Patients Undergoing Combined Open Hepatic Resection for Liver Metastases

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Abstract

Background

Safety and efficacy of simultaneous resections for patients with colorectal cancer and synchronous liver metastases have been widely reported, while the topic of approach (laparoscopic or open) to hepatic and colorectal resection is still a debated issue. The aim of this study was to assess short-term outcome of combined resection of left colon or rectum cancer and liver metastases, comparing the results of the primary tumor resection performed by laparoscopic or open approach.

Study design

From January 2004 to March 2014, 106 patients underwent combined resection of colorectal cancer and synchronous liver metastases. Sixty-nine patients underwent laparoscopic colorectal resection (laparoscopic colorectal surgery, LCS Group), and were compared with 37 patients undergoing colorectal resection by laparotomy (totally open surgery, TOS Group). Hepatic resection was performed by open approach in all the patients.

Results

Groups were comparable in terms of patients and disease characteristics, extent of liver resection, and length of surgery. In LCS Group, blood loss (400 vs. 650 mL, p < 0.001) and rate of intraoperative transfusions (19.3 vs. 47.2 %, p = 0.04) were lower compared to TOS Group. LCS Group was associated with reduced postoperative morbidity (24.6 vs. 44.4 %, p = 0.039), and shorter postoperative median hospital stay (9 vs. 13 days, p < 0.001). LCS and TOS Groups had comparable oncologic radicality in terms of primary tumor lymphadenectomy (median number of removed nodes 19 and 20, respectively, p NS) and rate of R1 colorectal resections (two patients in both Groups). Multivariate analysis revealed significant correlation morbidity with preoperative chemotherapy, blood loss, and approach to primary tumor.

Conclusions

Laparoscopic resection of colorectal cancer in patients undergoing simultaneous open resection of liver metastases is associated with a reduction of blood loss, morbidity, and postoperative hospital stay, without affecting oncologic radicality. Outcome is mainly conditioned by approach to intestinal surgery, rather than the extent of liver resection.

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Abbreviations

CRC:

Colorectal cancer

SCLM:

Synchronous colorectal liver metastases

TOS:

Totally open surgery

CLS:

Colorectal laparoscopic surgery

CLM:

Colorectal liver metastases

PVE:

Portal vein embolization

References

  1. Lykoudis PM, O’Reilly D, Nastos K et al (2014) Systematic review of surgical management of synchronous colorectal liver metastases. Br J Surg 101(6):605–612

    Article  CAS  PubMed  Google Scholar 

  2. Bretagnol F, Hatwell C, Farges O et al (2008) Benefit of laparoscopy for rectal resection in patents operated simultaneously for synchronous liver metastases: Preliminary experience. Surgery 144(3):436–441

    Article  PubMed  Google Scholar 

  3. Capussotti L, Ferrero A, Viganò L et al (2007) Major liver resections synchronous with colorectal surgery. Ann Surg Oncol 14(1):195–201

    Article  PubMed  Google Scholar 

  4. Slesser AA, Simillis C, Goldin R et al (2013) A meta-analysis comparing simultaneous versus delayed resections in patients with synchronous colorectal liver metastases. Surg Oncol 22(1):36–47

    Article  CAS  PubMed  Google Scholar 

  5. Mayo SC, Pulitanò C, Margues H et al (2013) Surgical management of patients with synchronous colorectal liver metastases: a multicenter international analysis. J Am Coll Surg 216(4):707–716

    Article  PubMed Central  PubMed  Google Scholar 

  6. Yin Z, Liu C, Chen Y et al (2013) Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): simultaneous or delayed? Hepatology 57(6):2346–2357

    Article  PubMed  Google Scholar 

  7. Huh JW, Koh YS, Kim HR et al (2011) Comparison of laparoscopic and open colorectal resections for patients undergoing simultaneous R0 resection for liver metastases. Surg Endosc 25(1):193–198

    Article  PubMed  Google Scholar 

  8. Kim SH, Lim SB, Ha YH et al (2008) Laparoscopic-assisted combined colon and liver resection for primary colorectal cancer with synchronous liver metastases: initial experience. World J Surg 32:2701–2706. doi:10.1007/s00268-008-9761-z

    Article  PubMed  Google Scholar 

  9. Akiyoshi T, Kuroyanagi H, Oya M et al (2009) Laparoscopic rectal resection for primary rectal cancer combined with open major upper abdominal surgery: initial experience. Hepatogastroenterology 56(91–92):571–574

    PubMed  Google Scholar 

  10. Sasanuma H, Mortensen FV, Hyodo M et al (2007) Effects of simultaneous hepatic resection on healing of left sided colonic anastomoses: an initial experience. Eur Surg Res 39(1):17–22

    Article  PubMed  Google Scholar 

  11. Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124

    Article  CAS  PubMed  Google Scholar 

  12. Orsenigo E, Di Palo S, Vignali A et al (2007) Intersphincteric Laparoscopic resection for low rectal cancer. Surg Oncol 16(Suppl 1):S117–S120

    Article  PubMed  Google Scholar 

  13. Staudacher C, Di Palo S, Tamburini A et al (2007) Total mesorectal excision (TME) with laparoscopic approach: 226 consecutive cases. Surg Oncol 16(Suppl 1):S113–S116

    Article  PubMed  Google Scholar 

  14. Vignali A, Ghirardelli L, Di Palo S et al (2013) Laparoscopic treatment of advanced colonic cancer: a case-matched control with open surgery. Colorectal Dis 15(8):944–948

    Article  CAS  PubMed  Google Scholar 

  15. Jegatheeswaran S, Mason JM, Hancock HC, Siriwardena AK (2013) The liver-first approach to the management of colorectal cancer with synchronous hepatic metastases: a systematic review. JAMA Surg 148(4):385–391

    Article  CAS  PubMed  Google Scholar 

  16. Nordlinger B, Van Cutsem E, Gruenberger T et al (2009) Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases: recommendation from an expert panel. Ann Oncol 20(6):985–992

    Article  CAS  PubMed  Google Scholar 

  17. Nordlinger B, GuiguetM Vaillant JC et al (1996) Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 77:1224–1262

    Article  Google Scholar 

  18. Arru M, Aldrighetti L, Castoldi R et al (2008) Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer. World J Surg 32(1):93–103. doi:10.1007/s00268-007-9285-y

    Article  PubMed  Google Scholar 

  19. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242(1):83–91

    Article  PubMed Central  PubMed  Google Scholar 

  20. Belghiti J, Clavien PA, Gadzijev E et al (2000) The Brisbane terminology of liver anatomy and resections. HPB 2000(2):333–339

    Google Scholar 

  21. Aldrighetti L, Pulitanò C, Arru M et al (2006) “Technological” approach versus clamp crushing technique for hepatic parenchymal transection: a comparative study. J Gastrointest Surg 10(7):974–979

    Article  PubMed  Google Scholar 

  22. Kirchhoff P, Dincler S, Buchmann P (2008) A multivariate analysis of potential risk factors for intra-and post-operative complications in 1316 elective laparoscopic colorectal procedures. Ann Surg 248:259–265

    Article  PubMed  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

  24. Capussotti L, Viganò L, Giuliante F et al (2009) Liver dysfunction and sepsis determine operative mortality after liver resection. Br J surg 96(1):88–94

    Article  CAS  PubMed  Google Scholar 

  25. Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg 250(5):825–830

    Article  PubMed  Google Scholar 

  26. Pulitanò C, Aldrighetti L (2008) The current role of laparoscopic liver resection for the treatment of liver tumours. Nat Clin Pract Gastroenterol Hepatol 5(11):648–654

    Article  PubMed  Google Scholar 

  27. Lupinacci RM, Andraus W, De Paiva Hahhad LB et al (2014) Simultaneous laparoscopic resection of primary colorectal cancer and associated liver metastases: a systematic review. Tech Coloproctol 18(2):129–135

    Article  CAS  PubMed  Google Scholar 

  28. Wang L, Tan HM, Tan JW et al (2013) Laparoscopic approach for simultaneous treatment of rectal cancer and synchronous liver metastases: indications and initial experience. Hepatogastroenterology 60(122):217–221

    CAS  PubMed  Google Scholar 

  29. Adam R, Pascal G, Azoulay D et al (2003) Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 238(6):871–883

    Article  PubMed Central  PubMed  Google Scholar 

  30. Giuliante F, Ardito F, Ferrero A et al (2014) Tumour progression during preoperative chemotherapy predicts failure to complete 2-stage hepatectomy for colorectal liver metastases: results from an Italian multicenter analysis of 130 patients. J Am Coll Surg 219(2):285–294

    Article  PubMed  Google Scholar 

  31. Karoui M, Viganò L, Goyer P et al (2010) Combined first-stage hepatectomy and colorectal resection in a two-stage hepatectomy strategy for bilobar synchronous liver metastases. Br J Surg 97(9):1354–1362

    Article  CAS  PubMed  Google Scholar 

  32. Ratti F, Cipriani F, Catena M et al (2014) Liver failure in patients treated with chemotherapy for colorectal liver metastases: Role of chronic disease scores in patients undergoing major liver surgery. A case-matched analysis. Eur J Surg Oncol 40(11):1550–1556

    Article  CAS  PubMed  Google Scholar 

  33. Lam VW, Laurence JM, Pang T et al (2014) A systematic review of a liver-first approach in patients with colorectal cancer and synchronous liver metastases. HPB 16(2):101–108

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hepatobiliary Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy

    Francesca Ratti, Marco Catena & Luca Aldrighetti

  2. Gastrointestinal Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy

    Saverio Di Palo & Carlo Staudacher

Authors
  1. Francesca Ratti
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  2. Marco Catena
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  3. Saverio Di Palo
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  4. Carlo Staudacher
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  5. Luca Aldrighetti
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Correspondence to Francesca Ratti.

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The authors of this manuscript have no conflicts of interest to disclose and further disclose any commercial interest that they may have in the subject of study and the source of any financial or material support.

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Ratti, F., Catena, M., Di Palo, S. et al. Laparoscopic Approach for Primary Colorectal Cancer Improves Outcome of Patients Undergoing Combined Open Hepatic Resection for Liver Metastases. World J Surg 39, 2573–2582 (2015). https://doi.org/10.1007/s00268-015-3127-0

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  • DOI: https://doi.org/10.1007/s00268-015-3127-0

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