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

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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.

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References

  1. Boyle P, Langman JS (2000) ABC of colorectal cancer: epidemiology. BMJ 321:805–808

    Article  PubMed  CAS  Google Scholar 

  2. 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  PubMed  CAS  Google Scholar 

  3. 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  PubMed  CAS  Google Scholar 

  4. 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 

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

    Article  PubMed  Google Scholar 

  6. Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, Antoniou A (2007) Laparoscopic versus open hepatic resections for benign and malignant neoplasms–a meta-analysis. Surgery 141:203–211

    Article  PubMed  Google Scholar 

  7. Polignano FM, Quyn AJ, de Figueiredo RS, Henderson NA, Kulli C, Tait IS (2008) Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc 22:2564–2570

    Article  PubMed  Google Scholar 

  8. Kim SH, Lim SB, Ha YH, Han SS, Park SJ, Choi HS, Jeong SY (2008) Laparoscopic-assisted combined colon and liver resection for primary colorectal cancer with synchronous liver metastases: initial experience. World J Surg 32:2701–2706

    Article  PubMed  Google Scholar 

  9. Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Lapalorcia LM, Casciola L (2009) Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study. J Hepatobiliary Pancreat Surg 16:450–457

    Article  PubMed  Google Scholar 

  10. Bretagnol F, Hatwell C, Farges O, Alves A, Belghiti J, Panis Y (2008) Benefit of laparoscopy for rectal resection in patients operated simultaneously for synchronous liver metastases: preliminary experience. Surgery 144:436–441

    Article  PubMed  Google Scholar 

  11. Geiger TM, Tebb ZD, Sato E, Miedema BW, Awad ZT (2006) Laparoscopic resection of colon cancer and synchronous liver metastasis. J Laparoendosc Adv Surg Tech A 16:51–53

    Article  PubMed  Google Scholar 

  12. Akiyoshi T, Kuroyanagi H, Saiura A, Fujimoto Y, Koga R, Konishi T, Ueno M, Oya M, Seki M, Yamaguchi T (2009) Simultaneous resection of colorectal cancer and synchronous liver metastases: initial experience of laparoscopy for colorectal cancer resection. Dig Surg 26:471–475

    Article  PubMed  Google Scholar 

  13. Akiyoshi T, Fujimoto Y, Konishi T, Kuroyanagi H, Ueno M, Oya M, Miyata S, Yamaguchi T (2011) Prognostic factors for survival after salvage surgery for locoregional recurrence of colon cancer. Am J Surg 201(6):726–733

    Article  PubMed  Google Scholar 

  14. Leung KL, Lee JF, Yiu RY, Ng SS, Li JC (2006) Simultaneous laparoscopic resection of rectal cancer and liver metastasis. J Laparoendosc Adv Surg Tech A 16:486–488

    Article  PubMed  Google Scholar 

  15. Adam R (2007) Colorectal cancer with synchronous liver metastases. Br J Surg 94:129–131

    Article  PubMed  CAS  Google Scholar 

  16. Leonard GD, Brenner B, Kemeny NE (2005) Neoadjuvant chemotherapy before liver resection for patients with unresectable liver metastases from colorectal carcinoma. J Clin Oncol 23:2038–2048

    Article  PubMed  CAS  Google Scholar 

  17. Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239:818–825 discussion 825-817

    Article  PubMed  Google Scholar 

  18. 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  Google Scholar 

  19. Abdalla EK, Adam R, Bilchik AJ, Jaeck D, Vauthey JN, Mahvi D (2006) Improving resectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 13:1271–1280

    Article  PubMed  Google Scholar 

  20. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  PubMed  CAS  Google Scholar 

  21. 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  PubMed  CAS  Google Scholar 

  22. Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D (2003) Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg 90:956–962

    Article  PubMed  CAS  Google Scholar 

  23. Capussotti L, Vigano L, Ferrero A, Lo Tesoriere R, Ribero D, Polastri R (2007) Timing of resection of liver metastases synchronous to colorectal tumor: proposal of prognosis-based decisional model. Ann Surg Oncol 14:1143–1150

    Article  PubMed  Google Scholar 

  24. Vassiliou I, Arkadopoulos N, Theodosopoulos T, Fragulidis G, Marinis A, Kondi-Paphiti A, Samanides L, Polydorou A, Gennatas C, Voros D, Smyrniotis V (2007) Surgical approaches of resectable synchronous colorectal liver metastases: timing considerations. World J Gastroenterol 13:1431–1434

    PubMed  Google Scholar 

  25. Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R, Jarnagin W, Blumgart L (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197:233–241 discussion 241–232

    Article  PubMed  Google Scholar 

  26. de Haas RJ, Adam R, Wicherts DA, Azoulay D, Bismuth H, Vibert E, Salloum C, Perdigao F, Benkabbou A, Castaing D (2011) Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases. Br J Surg 97:1279–1289

    Article  Google Scholar 

  27. 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(1):193–198

    Article  PubMed  Google Scholar 

  28. 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 

  29. 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 

  30. 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  PubMed  CAS  Google Scholar 

  31. Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328

    Article  PubMed  Google Scholar 

  32. 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 

  33. Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L, Barbas AS, Abdalla EK, Choti MA, Vauthey JN, Ludwig KA, Mantyh CR, Morse MA, Clary BM (2007) Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 14:3481–3491

    Article  PubMed  Google Scholar 

  34. Demicheli R, Retsky MW, Hrushesky WJ, Baum M, Gukas ID (2008) The effects of surgery on tumor growth: a century of investigations. Ann Oncol 19:1821–1828

    Article  PubMed  CAS  Google Scholar 

  35. Verhoef C, van der Pool AE, Nuyttens JJ, Planting AS, Eggermont AM, de Wilt JH (2009) The “liver-first approach” for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum 52:23–30

    Article  PubMed  Google Scholar 

  36. Cady B, Jenkins RL, Steele GD Jr, Lewis WD, Stone MD, McDermott WV, Jessup JM, Bothe A, Lalor P, Lovett EJ, Lavin P, Linehan DC (1998) Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. Ann Surg 227:566–571

    Article  PubMed  CAS  Google Scholar 

  37. Scudamore CH, Lee SI, Patterson EJ, Buczkowski AK, July LV, Chung SW, Buckley AR, Ho SG, Owen DA (1999) Radiofrequency ablation followed by resection of malignant liver tumors. Am J Surg 177:411–417

    Article  PubMed  CAS  Google Scholar 

  38. Oshowo A, Gillams AR, Lees WR, Taylor I (2003) Radiofrequency ablation extends the scope of surgery in colorectal liver metastases. Eur J Surg Oncol 29:244–247

    Article  PubMed  CAS  Google Scholar 

  39. Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171

    Article  PubMed  Google Scholar 

  40. Feliberti EC, Wagman LD (2006) Radiofrequency ablation of liver metastases from colorectal carcinoma. Cancer Control 13:48–51

    PubMed  Google Scholar 

  41. Berber E, Senagore A, Remzi F, Rogers S, Herceg N, Casto K, Siperstein A (2004) Laparoscopic radiofrequency ablation of liver tumors combined with colorectal procedures. Surg Laparosc Endosc Percutan Tech 14:186–190

    Article  PubMed  Google Scholar 

  42. Ishizawa T (2012) Synchronous metastases: techniques and clinical strategies. Surg Endosc 26(Supp 1):1

    Google Scholar 

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Disclosure

Drs. Polignano, Quyn, Henderson, Sanjay, and Tait have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Hepatobiliary and Advanced Laparoscopic Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK

    Francesco M. Polignano, Aaron J. Quyn, Pandanaboyana Sanjay, Nikola A. Henderson & Iain S. Tait

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  1. Francesco M. Polignano
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  2. Aaron J. Quyn
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Correspondence to Francesco M. Polignano.

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Polignano, F.M., Quyn, A.J., Sanjay, P. et al. Totally laparoscopic strategies for the management of colorectal cancer with synchronous liver metastasis. Surg Endosc 26, 2571–2578 (2012). https://doi.org/10.1007/s00464-012-2235-2

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  • DOI: https://doi.org/10.1007/s00464-012-2235-2

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