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Totally laparoscopic simultaneous resection of colorectal cancer and synchronous liver metastases: a single-center case series

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Abstract

Background

The aim of the study is to analyze the feasibility, the safety and short- and medium-term survival of totally laparoscopic simultaneous resections (LSR) of colorectal cancer (CRC) and synchronous liver metastases (LM).

Methods

This is a retrospective study of a single-center series. Patients ASA IV, ECOG ≥ 2, major hepatectomies (≥ 3 segments), symptomatic CRC as well as low rectal tumors were excluded from indication. The difficulty level of all liver resections was classified as low or intermediate according to the Iwate Criteria. Dindo–Clavien classification for postoperative complications evaluation was used.

Results

15 Patients with 21 liver lesions were included. Laparoscopic liver surgery was performed first in every case. Median size of the lesions was 20 mm (r 8–69). Major complications (Dindo–Clavien ≥ 3) occurred in 3 patients (20%); median hospital stay was 7 days (r 4–35), and only one patient (6.6%) was readmitted upon the first month from the surgery. 90-day mortality rate was 0%. After a median follow-up of 24 months (r 7–121), disease-free survival at 1, 2 and 3 years was 58%, 36% and 24%, respectively; overall survival at 1, 2 and 3 years was 92.3%.

Conclusions

In selected patients, LSR of CRC and LM is technically feasible and has an acceptable morbidity rate and mid-term survival.

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References

  1. Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D et al (2016) ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 27(8):1386–1422

    Article  Google Scholar 

  2. Weiser MR, Jarnagin WR, Saltz LB (2013) Colorectal cancer patients with oligometastatic liver disease: what is the optimal approach? Oncology 27:1074–1078

    PubMed  Google Scholar 

  3. Elías D, Detroz B, Lasser P, Plaud B, Jerbi G (1995) Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg 169(2):254–260

    Article  Google Scholar 

  4. Martin R, Pay P, Fong Y, Grace A, Cohen A, DeMatteo R et al (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197(2):233–241

    Article  Google Scholar 

  5. Ono Y, Saiura A, Arita J, Takahashi Y, Takahashi M, Inoue Y (2017) Short-term outcomes after simultaneous colorectal and major hepatic resection for synchronous colorectal liver metastases. Dig Surg 34(6):447–454

    Article  Google Scholar 

  6. de Haas RJ, Adam R, Wicherts DA, Azoulay D, Bismuth H, Vibert E et al (2010) Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases. Br J Surg 97(8):1279–1289

    Article  Google Scholar 

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

    Article  Google Scholar 

  8. Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y et al (2014) A novel difficulty scoring for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:745–753

    Article  Google Scholar 

  9. Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW et al (2018) Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 267:199–207

    Article  Google Scholar 

  10. Ciria R, Ocaña S, Gómez-Luque I, Cipriani F, Halls M, Fretland A et al (2020) A systematic review and meta-analysis comparing the short and long term outcomes for laparoscopic and open liver resections for liver metastases from colorectal cancer. Surg Endosc 34(1):349–360

    Article  Google Scholar 

  11. Cherqui D (2016) Evolution of laparoscopic liver resection. Br J Surg 103(11):1405–1407

    Article  CAS  Google Scholar 

  12. Cipriani F, Rawashdeh M, Stanton L, Armstrong T, Takhar A, Pearse NW et al (2016) Propensity score-based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases. Br J Surg 103(11):1504–1512

    Article  CAS  Google Scholar 

  13. Allard MA, Sa Cunha A, Gayet B, Adam R, Goere D, Bachelier P et al (2015) Early and long-term oncological outcomes after laparoscopic resection for colorectal liver metastases. Ann Surg 262:794–802

    Article  Google Scholar 

  14. Hoekstra LT, Busch OR, Bemelman WA, van Gulik TM, Tanis PJ (2012) Initial experiences of simultaneous laparoscopic resection of colorectal cancer and liver metastases. HPB Surg. https://doi.org/10.1155/2012/893956

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ivanecz A, Krebs B, Stozer A, Jagric T, Plahuta I (2018) Simultaneous pure laparoscopic resection of primary colorectal cancer and synchronous liver metastases: a single institution experience with propensity score matching analysis. Radiol Oncol 52(1):42–53

    Article  Google Scholar 

  16. Takorov I, Belev N, Lukanova T, Atanasov DG, Djurkov V et al (2016) Laparoscopic combined colorectal and liver resections for primary colorectal cancer with synchronous liver metastases. Ann Hepatobiliary Pancreat Surg 20:167–172

    Article  Google Scholar 

  17. Moris D, Tsilimigras D, Machairas N, Merath K, Cerullo M, Hasemaki N et al (2019) Laparoscopic synchronous resection of colorectal cancer and liver metastases: a systematic review. J Surg Oncol 119(1):30–39

    Article  Google Scholar 

  18. Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler A, Orgill DP, for the PROCESS Group (2018) The PROCESS 2018 Statement: Updating Consensus Preferred Reporting Of CasE Series in Surgery (PROCESS) Guidelines. Int J Surg 60:279–282

  19. 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  Google Scholar 

  20. 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  Google Scholar 

  21. Rotellar F, Pardo F, Bueno A, Martí-Cruchaga P, Zozaya G (2012) Extracorporeal tourniquet method for intermittent hepatic pedicle clamping during laparoscopic liver surgery: an easy, cheap, and effective technique. Langenbecks Arch Surg 397(3):481–485

    Article  Google Scholar 

  22. Waisberg J, Ivankovics IG (2015) Liver-first approach of colorectal cancer with synchronous hepatic metastases: a reverse strategy. World J Hepatol 18(11):1444–1449

    Article  Google Scholar 

  23. Ejaz A, Semenov E, Spolverato G, Kim Y, Tanner D, Hundt J et al (2014) Synchronous primary colorectal and liver metastasis: impact of operative approach on clinical outcomes and hospital charges. HPB (Oxf) 16:1117–1126

    Article  Google Scholar 

  24. Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L et al (2007) Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 14(12):3481–3491

    Article  Google Scholar 

  25. Adam R, de Gramont A, Figueras J, Kokudo N, Kunstlinger F, Loyer E et al (2015) Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev 42:729–741

    Article  Google Scholar 

  26. Van der Poel MJ, Tanis PJ, Marsman HA, Rijken AM, Gertsen EC, Ovaere S et al (2019) Laparoscopic combined resection of liver metastases and colorectal cancer: a multicenter, case-matched study using propensity scores. Surg Endosc 33:1124–1130

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  28. Vera R, González-Flores E, Rubio C et al (2020) Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM. Clin Transl Oncol 22:647–662

    Article  CAS  Google Scholar 

  29. Chen YW, Huang MT, Chang TC (2019) Long term outcomes of simultaneous laparoscopic versus open resection for colorectal cancer with synchronous liver metastases. Asian J Surg 42:217–223

    Article  Google Scholar 

  30. Xu X, Guo Y, Chen G, Li C, Wang H, Dong G (2019) Laparoscopic resections of colorectal cancer and synchronous liver metastases: a case controlled study. Minim Invasive Ther Allied Technol 27(4):2019–2216

    Google Scholar 

  31. De Jong MC, Pulitano C, Ribero D, Strub J, Mentha G, Schulick R et al (2009) Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis. An international multi-institutional analysis of 1669 patients. Ann Surg 250:440–448

    Article  Google Scholar 

  32. Mentha G, Majno P, Andres A, Rubbia-Brandt L, Morel P, Roth A (2006) Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg 93(6):872–878

    Article  CAS  Google Scholar 

  33. Welsh F, Chandrakumaran K, John T, Cresswell A, Ress M (2016) Propensity score-matched outcomes analysis of the liver-first approach for synchronous colorectal liver metastases. BJS 103:600–606

    Article  CAS  Google Scholar 

  34. Andres A, Toso C, Adam R, Barroso E, Hubert C, Capussotti L et al (2012) A survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases. Ann Surg 256:772–779

    Article  Google Scholar 

  35. De Jong M, Beckers R, Van Woerden V, Sijmons J, Bemelmans M et al (2018) The liver-first approach for synchronous colorectal liver metastases: more than a decade of experience in a single centre. HPB 20:631–640

    Article  Google Scholar 

  36. Kelly M, Spolverato G, Lê G, Mavros M, Doyle F, Pawlik T et al (2015) Synchronous colorectal liver metastasis: a network meta-analysis review comparing classical, combined, and liver-first surgical strategies. J Surg Oncol 111(341):315

    Google Scholar 

  37. Sturesson C, Valdimarsson V, Blomstrand E, Eriksson S, Nilsson J, Syk I et al (2017) Liver-first strategy for synchronous colorectal liver metastases—an intention-to-treat analysis. HPB 19:52–58

    Article  Google Scholar 

  38. Baltatzis M, Chan A, Jegatheeswaran S, Mason J, Siriwardena AK (2016) Colorectal cancer with synchronous hepatic metastases: systematic review of reports comparing synchronous surgery with sequential bowel-first or liver-first approaches. EJSO 42:159–165

    Article  CAS  Google Scholar 

  39. Mayo S, Pulitano C, Marques H, Lamelas J, Wolfgang C, De Saussure W et al (2013) Surgical management of patients with synchronous colorectal liver metastasis: a multicenter international analysis. J Am Coll Surg 216(4):707–716

    Article  Google Scholar 

  40. Brouquet A, Mortenson M, Vauthey J, Rodriguez-Bigas M, Overman M, Chang G et al (2010) Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined or reverse strategy? J Am Coll Surg 210(6):934–941

    Article  Google Scholar 

  41. Yoshioka R, Hasegawa K, Mise Y, Oba M, Aoki T, Sakamoto Y et al (2014) Evaluation of the safety and efficacy of simultaneous resection of primary colorectal cancer and synchronous colorectal liver metastases. Surgery 155:478–485

    Article  Google Scholar 

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Authors and Affiliations

  1. Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain

    Arkaitz Perfecto, Mikel Gastaca, Mikel Prieto, Patricia Ruiz, Alberto Ventoso, Ibone Palomares & Andrés Valdivieso

  2. University of the Basque Country, Leioa, Spain

    Mikel Gastaca, Mikel Prieto, Jorge Cervera, José María García & Andrés Valdivieso

  3. Coloproctology Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, Barakaldo, 48903, Spain

    Jorge Cervera & José María García

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  1. Arkaitz Perfecto
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  2. Mikel Gastaca
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Correspondence to Mikel Gastaca.

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Drs. Arkaitz Perfecto, Mikel Gastaca, Mikel Prieto, Jorge Cervera, Patricia Ruiz, Alberto Ventoso, Ibone Palomares, José María García and Andrés Valdivieso have no conflicts of interest or financial ties to disclose.

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Perfecto, A., Gastaca, M., Prieto, M. et al. Totally laparoscopic simultaneous resection of colorectal cancer and synchronous liver metastases: a single-center case series. Surg Endosc 36, 980–987 (2022). https://doi.org/10.1007/s00464-021-08362-9

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  • DOI: https://doi.org/10.1007/s00464-021-08362-9

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