title: Laparoscopic approach for simultaneous treatment of rectal cancer and synchronous liver metastases:indications and initial experience.
abstract: OBJECTIVE
  Lapraoscopic era provided a new alternative for rectal cancer and synchronous liver metastases (RCLM). However, there is no established consensus for laparoscopy "first" for patients with RCLM, whose metastasis is confined to the liver. This study aimed to evaluate its indications for one-stage surgery in laparoscopy.
  
  
  METHODS
  Sixteen patients with RCLM, who had undergone laparoscopic colorectal resection and simultaneous treatment for liver metastasis, were retrospectively reviewed.
  
  
  RESULTS
  With concomitant laparoscopic colorectal resection, 6 patients received liver resection simultaneously; 10 patients underwent all sorts of down-staging managing including local ablation, right hepatic portal vein ligation and chemotherapy pumps implanted into hepatic artery for liver metastases. The colo-anal/rectal anastomoses were performed with a stapler or "pull-through" mode through the anus. Three patients underwent two-stage liver resection following tumor down-staging. Median survival time was 22.3 months.
  
  
  CONCLUSIONS
  Laparoscopy approach first for rectal cancer and synchronous liver metastasis is feasible in selected patients, and can provide curative resection or benefit "down-staging" treatment. Colon "pull-through" anastomosis is a potential method to avoid abdominal incision and decrease the risk of anastomotic leakage. It is worth investigating its advantages over traditional approaches with a prospective randomized controlled study.
authors.affiliation: General Surgery Department, Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian Province, China.
authors.forename: Lie
authors.initials: L
authors.lastname: Wang
authors.forename: Hua Min
authors.initials: HM
authors.lastname: Tan
authors.forename: Jing Wang
authors.initials: JW
authors.lastname: Tan
authors.forename: Yajuan
authors.initials: Y
authors.lastname: Chu
authors.forename: Xiang Min
authors.initials: XM
authors.lastname: Ding
authors.forename: Jia Hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies