title: One-stage, totally laparoscopic major hepatectomy and colectomy for colorectal neoplasm with synchronous liver metastasis: safety, feasibility and short-term outcome.
abstract: BACKGROUND
  Simultaneous surgery for primary colorectal tumor with synchronous liver metastasis has been showed to be safe and effective. One-stage, totally laparoscopic colorectal and minor liver resections have been reported, but there are no data regarding patients requiring simultaneous major hepatectomies and colorectal surgery. We aimed to evaluate the safety, feasibility and short-term outcomes of a small cohort of highly selected patients treated by 1-stage, totally laparoscopic major hepatectomy and colorectal resection.
  
  
  METHODS
  From January 2009 to July 2011, 5 patients (3 women and 2 men) with primary colorectal neoplasm and synchronous monolobar liver metastasis requiring a major hepatectomy underwent attempt of 1-stage, totally laparoscopic approach after neoadjuvant chemotherapy. A retrospective analysis of prospective collected data was performed.
  
  
  RESULTS
  There were no conversions to open procedures. All the patients but 1 underwent a 1-stage laparoscopic resection. Among these, liver procedures were 3 right and 1 left hepatectomy; colonic procedures were 3 sigmoidectomies and 1 anterior resection of the rectum. Median operative time was 495 minutes, and duration of hospital stay, 6 days. Median estimated blood loss was 475 mL (range, 300-630) with no mortality observed. An R0 resection was always achieved. Median follow-up was 14 months (range, 7-20) with 1 recurrence observed in the liver.
  
  
  CONCLUSIONS
  In highly selected patients, a totally laparoscopic approach is a feasible and safe option to treat primary colorectal neoplasm with synchronous liver metastasis requiring major hepatectomies. These results need to be validated by larger, prospective, randomized studies.
authors.affiliation: HPB and Advanced Laparoscopic Surgical Unit, Department of General and Minimally Invasive Surgery, Policlinico of Abano Terme, Abano Terme, Italy. mspampinato@policlinicoabano.it
authors.forename: Marcello Giuseppe
authors.initials: MG
authors.lastname: Spampinato
authors.forename: Lucio
authors.initials: L
authors.lastname: Mandalá
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Quarta
authors.forename: Pietro
authors.initials: P
authors.lastname: Del Medico
authors.forename: Gianandrea
authors.initials: G
authors.lastname: Baldazzi
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D061646:Operative Time; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome