Elsevier

Surgery

Volume 144, Issue 3, September 2008, Pages 436-441
Surgery

Original Communication
Benefit of laparoscopy for rectal resection in patients operated simultaneously for synchronous liver metastases: Preliminary experience

https://doi.org/10.1016/j.surg.2008.04.014Get rights and content

Background

Resection of the rectal primary neoplasm with synchronous liver metastases (LM) is warranted, because this is the only strategy with curative potential. Combined resection remains controversial because of the risk of morbidity and necessity of a curative abdominal approach to warrant liver resection. Laparoscopic colorectal resection may be beneficial and could facilitate this procedure.

Methods

Between February 2006 and June 2007, 10 patients underwent 1-step laparoscopic resection for primary rectal cancer combined with open resection of synchronous LM.

Results

All patients underwent a laparoscopic mesorectal excision (n = 10). Liver resections included right hepatectomy (n = 1), bi- or trisegmentectomy (n = 3), and metastasectomy (n = 6). The rectosigmoid specimen was extracted through the right subcostal or a short midline incision used for open liver resection, except in 3 patients who underwent a 1-step totally laparoscopic resection of both the colorectal and hepatic neoplasms. The overall morbidity was 40%. The median hospital stay was 12 days (range, 5–40). Overall morbidity (29% vs 40%) and hospital stay (12 vs 12 days) were similar to those observed in a previous cohort of 27 patients undergoing laparoscopic mesorectal excision only.

Conclusion

This pilot study suggests that laparoscopic rectal resection with synchronous resection of LM is feasible with low morbidity and short hospital stay. Moreover, laparoscopy facilitates the operation approach for synchronous major hepatectomy.

Section snippets

Patient selection

Since the beginning of 2006, all patients who had histologically proven rectal adenocarcinoma associated with synchronous LM were entered into a prospective trial of combined rectal and liver resection. Rectal cancer was defined as a neoplasm located within 15 cm of the anal verge. Synchronous LM were defined as those identified at the time of diagnosis of the primary colorectal neoplasm. Inclusion criteria were a resectable colorectal cancer as assessed in all patients by endorectal

Patient characteristics

We assessed prospectively the medical data of 24 patients who underwent concurrent or staged laparoscopic resection of the primary colorectal neoplasm with synchronous LMs at Beaujon Hospital between February 2006 and June 2007. We excluded patients with a 2-step procedure, including laparoscopic colorectal resection with delayed liver resection (n = 7) and patients with a 1-step procedure but with a primary nonrectal neoplasm (n = 7).

Ten patients fulfilled the inclusion criteria. There were 6

Discussion

This pilot study was designed to focus on the possible benefits of laparoscopic approach during simultaneous rectal and liver resection for stage IV colon and rectal cancer. The present study is one of the first suggesting the role of laparoscopy in the operative management of rectal cancer with resectable synchronous LMs. To our knowledge, only 1 case report has been reported on this topic.20 In the current study, we showed that laparoscopic rectal resection with synchronous LM was feasible

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