title: Laparoscopic Simultaneous Resection of Colorectal Primary Tumor and Liver Metastases: Results of a Multicenter International Study.
abstract: BACKGROUND
  With the advance of modern laparoscopic technology, laparoscopic colorectal surgery and laparoscopic liver surgery are both worldwide accepted. Preliminary brief series have shown the feasibility of combined laparoscopic resection of colorectal cancer (CRC) and synchronous colorectal liver metastases (SCRLM). We aim to report a large International multicenter series of laparoscopic simultaneous resection of CRC and SCRLM.
  
  
  METHODS
  Between 1997 and 2013, 142 laparoscopic liver resections were performed with simultaneous colorectal surgery for SCRLM. The surgical and postoperative variables evaluated were the duration of the intervention, blood loss, transfusion rate, conversion rate, resection margin, specific and overall morbidity, perioperative mortality, length of hospital stay, and survival. Univariate and multivariate analyses were performed examining postoperative morbidity in the all cohort of patients.
  
  
  RESULTS
  The median number of liver lesions was 1 (1-9) and the median larger diameter at diagnosis was 28 (2-100) mm. The median operative time was 360 (120-690) min. Seven patients (4.9%) required conversion. The global morbidity was 31.0% and the mortality was 2.1%. After a median follow-up of 29 (1-108) months, 40 patients (28.2%) developed tumor recurrence. Curative treatment of recurrence was possible in 17 patients (12.0%), including a second liver resection in 13 patients (9.1%), which was performed by laparoscopy in 7 patients (4.9%). Overall 1-, 3-, and 5-year survivals were 98.8, 82.1, and 71.9%, respectively. By multivariate analysis, ASA score≥3 [OR 13.6 (1.8-99.6); P=0.01] and operative time [OR 1.008 (1.001-1.016); P=0.03] were independent predictors of postoperative morbidity.
  
  
  CONCLUSIONS
  Our combined data show that in experienced centers, simultaneous laparoscopic approach is technically feasible, safe, and associated with good oncological outcomes.
authors: Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Paris-Sud University, 157 rue de la Porte de Trivaux, 92141, Clamart, France.
authors: Stefano
authors: S
authors: Ferretti
authors: Hadrien
authors: H
authors: Tranchart
authors: Joseph F
authors: JF
authors: Buell
authors: Constantino
authors: C
authors: Eretta
authors: Alberto
authors: A
authors: Patriti
authors: Marcello Giuseppe
authors: MG
authors: Spampinato
authors: Jung Wook
authors: JW
authors: Huh
authors: Luca
authors: L
authors: Vigano
authors: Ho Seong
authors: HS
authors: Han
authors: Giuseppe Maria
authors: GM
authors: Ettorre
authors: Elio
authors: E
authors: Jovine
authors: Thomas Clark
authors: TC
authors: Gamblin
authors: Giulio
authors: G
authors: Belli
authors: Go
authors: G
authors: Wakabayashi
authors: Brice
authors: B
authors: Gayet
authors: Ibrahim
authors: I
authors: Dagher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors