The preliminary experience in simultaneous treatment of rectal cancer and synchronous liver metastases with laparoscopy.
OBJECTIVE
There is no consensus for laparoscopy first in patients with rectal cancer and synchronous liver metastases, whose metastases are confined to the liver. This study aimed to evaluate its indications for one-stage surgery in laparoscopy.


METHODS
Eighteen patients with rectal cancer and synchronous liver metastases, who had undergone laparoscopic colorectal resection and simultaneous treatment for liver metastases, were retrospectively reviewed.


RESULTS
Concomitant with laparoscopic colorectal resection, eight patients received liver resection simultaneously; 10 patients underwent a variety of down-staging management including local ablation, right hepatic portal vein ligation, and implantation of chemotherapy pumps into the hepatic artery. The colo-anal/rectal anastomoses were performed with a stapler or "pull-though" mode though the anus. Three patients underwent two-stage liver resection following tumor down-staging. Median survival time was 22.3 months.


CONCLUSIONS
Laparoscopy approach for rectal cancer and synchronous liver metastases is feasible in selected patients. Colon pull-through anastomosis was a potential method to avoid abdominal incision and decrease the risk of anastomotic leakage. It is worth further investigation regarding its advantages over traditional modalities with a prospective randomized controlled study.
Institute of Hepatobiliary Surgery, PLA. General Hospital of Beijing, 28 Fuxing Road, Haidian District, Beijing 100853, China.
Ziman
Z
Zhu
Jing-Wang
JW
Tan
Hua-Min
HM
Tan
Ben-Shun
BS
Hu
Ke
K
Chen
Xiang-Min
XM
Ding
Jian-Jun
JJ
Leng
Fei
F
Chen
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003106:Colon / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006498:Hepatectomy; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D015918:Infusion Pumps, Implantable; D010535:Laparoscopy; D002955:Leucovorin / Q000627:therapeutic use; D008026:Ligation; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil