title: Laparoscopic resection of colorectal cancer facilitates simultaneous surgery of synchronous liver metastases.
abstract: OBJECTIVE
  Combined resection of colorectal cancer with surgery for synchronous liver metastases (LM) still remains controversial because of the possible higher morbidity rate, the necessity of an adequate abdominal approach for both resections and the impact on oncological results. However, laparoscopy may be beneficial in terms of operative results and could facilitate this combined procedure. The aim was to assess the benefit of the laparoscopic approach for colorectal cancer resection in patients undergoing simultaneous liver resection for synchronous LM.
  
  
  METHODS
  From 2006 to 2011, all patients with colorectal cancer and resectable synchronous LM, for which the total length of the procedure was suspected to be less than 8 h, underwent colorectal laparoscopic resection combined with open and/or laparoscopic liver surgery. In order to identify selection criteria, a comparative analysis was performed between patients with and without major postoperative morbidity.
  
  
  RESULTS
  Fifty-one patients underwent combined surgery with laparoscopic colectomy (n = 31) and proctectomy (n = 20). The conversion rate was 8%. Liver resections included major surgery (n = 10) and minor surgery (n = 41). Extraction of the colorectal specimen was performed through an incision used for open liver resection, except in seven patients who underwent a total laparoscopic procedure. Overall and major morbidity rates were 55% and 25%, respectively. Median (range) hospital stay was 16 (6-40) days. Regarding patient and tumour characteristics, no independent criteria of major morbidity risk were identified.
  
  
  CONCLUSIONS
  This study showed that laparoscopic colorectal resection combined with liver resection for synchronous LM was feasible and safe. Moreover, laparoscopy facilitates the surgical abdominal approach for combined colorectal and liver resection.
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital (APHP), Clichy, France.
authors.forename: C
authors.initials: C
authors.lastname: Hatwell
authors.forename: F
authors.initials: F
authors.lastname: Bretagnol
authors.forename: O
authors.initials: O
authors.lastname: Farges
authors.forename: J
authors.initials: J
authors.lastname: Belghiti
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D000971:Antineoplastic Combined Chemotherapy Protocols; D059186:Chemoradiotherapy, Adjuvant; D016009:Chi-Square Distribution; D003082:Colectomy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D002955:Leucovorin / Q000008:administration & dosage; D008100:Liver Abscess / Q000209:etiology; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D061646:Operative Time; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D018579:Patient Selection; D010538:Peritonitis / Q000209:etiology; D011725:Pyridines / Q000008:administration & dosage; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D009944:Organoplatinum Compounds; D011725:Pyridines; C431073:oxiplatin; D002955:Leucovorin; D005472:Fluorouracil