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.
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Article info
Publication history
Published online: July 11, 2008
Accepted:
April 16,
2008
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
