Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic simultaneous resection of colorectal primary tumor and liver metastases: a propensity score matching analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Preliminary series have shown the feasibility of combined laparoscopic resection of colorectal cancer (CRC) and synchronous colorectal liver metastases (SCRLM). The aim of this study was to compare the short- and long-term outcomes for matched patients undergoing combined resections.

Methods

An international multicenter database of 142 patients that underwent combined laparoscopic resection of CRC and SCRLM between 1997 and 2013 was compared to a database of 241 patients treated by open during the same period. Comparison of short- and long-term outcomes was performed after propensity score adjustment.

Results

After matching, 89 patients were compared in each group including mostly ASA I–II patients, presenting with mean number of 1.5 CRLM, with a mean diameter of 30 mm, and resectable by a wedge resection or a left lateral sectionectomy. A rectal resection was required in 46 and 43 % of laparoscopic and open procedures, respectively (p = 0.65). There was no difference in global operative time, blood loss and transfusion rates between the two groups. A conversion was required in 7 % of the laparoscopic procedures. Morbidity rates were similar in the two groups (p = 1.0). The 3-year overall survival in the laparoscopy and open groups were 78 and 65 %, respectively (p = 0.17).

Conclusions

In patients without severe comorbidities presenting with one, small (≤3 cm), CRLM resectable by a wedge resection or a left lateral sectionectomy, combined laparoscopic resection of CRC and SCRLM allowed similar short- and long-term outcomes compared with the open approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. WHO (2003) World Cancer Report

  2. Leporrier J, Maurel J, Chiche L, Bara S, Segol P, Launoy G (2006) A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer. Br J Surg 93:465–474

    Article  CAS  PubMed  Google Scholar 

  3. Steele G Jr, Ravikumar TS (1989) Resection of hepatic metastases from colorectal cancer. Biologic perspective. Ann Surg 210:127–138

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, Lillemoe KD, Yeo CJ, Cameron JL (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766

    Article  PubMed  PubMed Central  Google Scholar 

  6. Minagawa M, Makuuchi M, Takayama T, Kokudo N (2003) Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238:703–710

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bolton JS, Fuhrman GM (2000) Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg 231:743–751

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Mentha G, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth AD (2006) Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg 93:872–878

    Article  CAS  PubMed  Google Scholar 

  9. Hillingso JG, Wille-Jorgensen P (2009) Staged or simultaneous resection of synchronous liver metastases from colorectal cancer—a systematic review. Colorectal Dis 11:3–10

    Article  CAS  PubMed  Google Scholar 

  10. Brouquet A, Mortenson MM, Vauthey JN, Rodriguez-Bigas MA, Overman MJ, Chang GJ, Kopetz S, Garrett C, Curley SA, Abdalla EK (2010) Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined or reverse strategy? J Am Coll Surg 210:934–941

    Article  PubMed  Google Scholar 

  11. Chen J, Li Q, Wang C, Zhu H, Shi Y, Zhao G (2011) Simultaneous vs. staged resection for synchronous colorectal liver metastases: a meta analysis. Int J Colorectal Dis 26:191–199

    Article  PubMed  Google Scholar 

  12. Capussotti L, Ferrero A, Vigano L, Ribero D, Lo Tesoriere R, Polastri R (2007) Major liver resections synchronous with colorectal surgery. Ann Surg Oncol 14:195–201

    Article  PubMed  Google Scholar 

  13. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  PubMed  Google Scholar 

  14. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  15. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  16. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830

    Article  PubMed  Google Scholar 

  17. Belli G, Gayet B, Han HS, Wakabayashi G, Kim KH, Cannon R, Kaneko H, Gamblin T, Koffron A, Dagher I, Buell JF (2013) Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care. Surg Endosc 27:2721–2726

    Article  PubMed  Google Scholar 

  18. Bagshaw PF, Allardyce RA, Frampton CM, Frizelle FA, Hewett PJ, McMurrick PJ, Rieger NA, Smith JS, Solomon MJ, Stevenson AR (2012) Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial. Ann Surg 256:915–919

    Article  PubMed  Google Scholar 

  19. Schiffman SC, Kim KH, Tsung A, Marsh JW, Geller DA (2014) Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery 157:211–222

    Article  PubMed  Google Scholar 

  20. Polignano FM, Quyn AJ, Sanjay P, Henderson NA, Tait IS (2012) Totally laparoscopic strategies for the management of colorectal cancer with synchronous liver metastasis. Surg Endosc 26:2571–2578

    Article  PubMed  Google Scholar 

  21. Spampinato MG, Mandala L, Quarta G, Del Medico P, Baldazzi G (2012) One-stage, totally laparoscopic major hepatectomy and colectomy for colorectal neoplasm with synchronous liver metastasis: safety, feasibility and short-term outcome. Surgery 153:861–865

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  23. Hatwell C, Bretagnol F, Farges O, Belghiti J, Panis Y (2013) Laparoscopic resection of colorectal cancer facilitates simultaneous surgery of synchronous liver metastases. Colorectal Dis 15:21–28

    Article  Google Scholar 

  24. Chen KY, Xiang GA, Wang HN, Xiao FL (2011) Simultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis. Chin Med J 124:2990–2992

    PubMed  Google Scholar 

  25. Lin Q, Ye Q, Zhu D, Wei Y, Ren L, Zheng P, Xu P, Ye L, Lv M, Fan J, Xu J (2014) Comparison of minimally invasive and open colorectal resections for patients undergoing simultaneous R0 resection for liver metastases: a propensity score analysis. Int J Colorectal Dis 30:385–395

    Article  PubMed  Google Scholar 

  26. Hu MG, Ou-yang CG, Zhao GD, Xu DB, Liu R (2012) Outcomes of open versus laparoscopic procedure for synchronous radical resection of liver metastatic colorectal cancer: a comparative study. Surg Laparosc Endosc Percutan Tech 22:364–369

    Article  PubMed  Google Scholar 

  27. Ferretti S, Tranchart H, Buell JF, Eretta C, Patriti A, Spampinato MG, Huh JW, Vigano L, Han HS, Ettorre GM, Jovine E, Gamblin TC, Belli G, Wakabayashi G, Gayet B, Dagher I (2015) Laparoscopic simultaneous resection of colorectal primary tumor and liver metastases: results of a multicentric international study. World J Surg 39:2052–2060

    Article  PubMed  Google Scholar 

  28. Vigano L, Langella S, Ferrero A, Russolillo N, Sperti E, Capussotti L (2013) Colorectal cancer with synchronous resectable liver metastases: monocentric management in a hepatobiliary referral center improves survival outcomes. Ann Surg Oncol 20:938–945

    Article  PubMed  Google Scholar 

  29. Tranchart H, Chirica M, Faron M, Balladur P, Lefevre LB, Svrcek M, de Gramont A, Tiret E, Paye F (2013) Prognostic impact of positive surgical margins after resection of colorectal cancer liver metastases: reappraisal in the era of modern chemotherapy. World J Surg 37:2647–2654

    Article  PubMed  Google Scholar 

  30. 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 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lemeshow S, Hosmer DW Jr (1982) A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 115:92–106

    CAS  PubMed  Google Scholar 

  32. Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, Jaeck D (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 77:1254–1262

    Article  CAS  PubMed  Google Scholar 

  33. Belghiti J (1990) Synchronous and resectable hepatic metastases of colorectal cancer: should there be a minimum delay before hepatic resection? Ann Chir 44:427–429

    CAS  PubMed  Google Scholar 

  34. Kimura F, Miyazaki M, Suwa T, Kakizaki S, Itoh H, Kaiho T, Ambiru S, Shimizu H (1996) Reduced hepatic acute-phase response after simultaneous resection for gastrointestinal cancer with synchronous liver metastases. Br J Surg 83:1002–1006

    Article  CAS  PubMed  Google Scholar 

  35. Elias D, Detroz B, Lasser P, Plaud B, Jerbi G (1995) Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg 169:254–260

    Article  CAS  PubMed  Google Scholar 

  36. Capussotti L, Vigano L, Giuliante F, Ferrero A, Giovannini I, Nuzzo G (2009) Liver dysfunction and sepsis determine operative mortality after liver resection. Br J Surg 96:88–94

    Article  CAS  PubMed  Google Scholar 

  37. Lin Q, Ye Q, Zhu D, Wei Y, Ren L, Ye L, Feng Q, Xu P, Zheng P, Lv M, Fan J, Xu J (2014) Determinants of long-term outcome in patients undergoing simultaneous resection of synchronous colorectal liver metastases. PLoS ONE 9:e105747

    Article  PubMed  PubMed Central  Google Scholar 

  38. Yoshioka R, Hasegawa K, Mise Y, Oba M, Aoki T, Sakamoto Y, Sugawara Y, Sunami E, Watanabe T, Kokudo N (2014) Evaluation of the safety and efficacy of simultaneous resection of primary colorectal cancer and synchronous colorectal liver metastases. Surgery 155:478–485

    Article  PubMed  Google Scholar 

  39. Mayo SC, Pulitano C, Marques H, Lamelas J, Wolfgang CL, de Saussure W, Choti MA, Gindrat I, Aldrighetti L, Barrosso E, Mentha G, Pawlik TM (2013) Surgical management of patients with synchronous colorectal liver metastasis: a multicenter international analysis. J Am Coll Surg 216:707–716

    Article  PubMed  PubMed Central  Google Scholar 

  40. Luo Y, Wang L, Chen C, Chen D, Huang M, Huang Y, Peng J, Lan P, Cui J, Cai S, Wang J (2010) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastases. J Gastrointest Surg 14:1974–1980

    Article  PubMed  Google Scholar 

  41. de Santibanes E, Fernandez D, Vaccaro C, Quintana GO, Bonadeo F, Pekolj J, Bonofiglio C, Molmenti E (2010) Short-term and long-term outcomes after simultaneous resection of colorectal malignancies and synchronous liver metastases. World J Surg 34:2133–2140

    Article  PubMed  Google Scholar 

  42. Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, Sugihara K, Watanabe M, Moriya Y, Kitano S, Japan Clinical Oncology Group Colorectal Cancer Study Group (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 260:23–30

    Article  PubMed  Google Scholar 

  43. van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC, Bonjer HJ (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218

    Article  PubMed  Google Scholar 

  44. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, Group CIS (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332

    Article  CAS  PubMed  Google Scholar 

  45. Trastulli S, Cirocchi R, Listorti C, Cavaliere D, Avenia N, Gulla N, Giustozzi G, Sciannameo F, Noya G, Boselli C (2012) Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis 14:277–296

    Article  Google Scholar 

  46. Wei M, He Y, Wang J, Chen N, Zhou Z, Wang Z (2014) Laparoscopic versus open hepatectomy with or without synchronous colectomy for colorectal liver metastasis: a meta-analysis. PLoS ONE 9:e87461

    Article  PubMed  PubMed Central  Google Scholar 

  47. Tranchart H, Diop PS, Lainas P, Pourcher G, Catherine L, Franco D, Dagher I (2011) Laparoscopic major hepatectomy can be safely performed with colorectal surgery for synchronous colorectal liver metastasis. HPB (Oxf) 13:46–50

    Article  Google Scholar 

  48. Adam R, De Gramont A, Figueras J, Guthrie A, Kokudo N, Kunstlinger F, Loyer E, Poston G, Rougier P, Rubbia-Brandt L, Sobrero A, Tabernero J, Teh C, Van Cutsem E, Jean-Nicolas Vauthey of the Eg (2012) The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist 17:1225–1239

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Nishiwada S, Ko S, Mukogawa T, Ishikawa H, Matsusaka M, Nakatani T, Kikuchi E, Watanabe A (2014) Comparison between percutaneous radiofrequency ablation and surgical hepatectomy focusing on local disease control rate for colorectal liver metastases. Hepatogastroenterology 61:436–441

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, Clamart, 92141, France

    Hadrien Tranchart, Stefano Ferretti & Ibrahim Dagher

  2. Paris-Sud University, Orsay, 91405, France

    Hadrien Tranchart, Stefano Ferretti & Ibrahim Dagher

  3. Department of Digestive Diseases, Institut Mutualiste Montsouris, Paris, 75014, France

    David Fuks & Brice Gayet

  4. Department of General and Oncological Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati 62, 10128, Turin, Italy

    Luca Vigano & Alessandro Ferrero

  5. Department of Hepatobiliary and General Surgery, Humanitas Research Hospital, IRCCS, Humanitas University, Via Manzoni 56, 20089, Rozzano, Milan, Italy

    Luca Vigano

  6. Department of General Surgery, Saint Antoine Hospital, 75012, Paris, France

    François Paye

  7. Department of Surgery, Iwate Medical University School of Medicine, Morioka, 020-8505, Japan

    Go Wakabayashi

Authors
  1. Hadrien Tranchart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Fuks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luca Vigano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefano Ferretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. François Paye
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Go Wakabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alessandro Ferrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brice Gayet
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ibrahim Dagher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ibrahim Dagher.

Ethics declarations

Disclosures

Hadrien Tranchart, David Fuks, Luca Vigano, Stefano Ferretti, François Paye, Go Wakabayashi, Alessandro Ferrero and Ibrahim Dagher have no conflicts of interest or financial ties to disclose. Brice Gayet received royalties for “Gayet bipolar forceps” (MicroFrance BG-CEV134, Medtronic, Minneapolis, MN, USA).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tranchart, H., Fuks, D., Vigano, L. et al. Laparoscopic simultaneous resection of colorectal primary tumor and liver metastases: a propensity score matching analysis. Surg Endosc 30, 1853–1862 (2016). https://doi.org/10.1007/s00464-015-4467-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4467-4

Keywords

Search

Navigation