title: Laparoscopic Approach for Primary Colorectal Cancer Improves Outcome of Patients Undergoing Combined Open Hepatic Resection for Liver Metastases.
abstract: BACKGROUND
  Safety and efficacy of simultaneous resections for patients with colorectal cancer and synchronous liver metastases have been widely reported, while the topic of approach (laparoscopic or open) to hepatic and colorectal resection is still a debated issue. The aim of this study was to assess short-term outcome of combined resection of left colon or rectum cancer and liver metastases, comparing the results of the primary tumor resection performed by laparoscopic or open approach.
  
  
  METHODS
  From January 2004 to March 2014, 106 patients underwent combined resection of colorectal cancer and synchronous liver metastases. Sixty-nine patients underwent laparoscopic colorectal resection (laparoscopic colorectal surgery, LCS Group), and were compared with 37 patients undergoing colorectal resection by laparotomy (totally open surgery, TOS Group). Hepatic resection was performed by open approach in all the patients.
  
  
  RESULTS
  Groups were comparable in terms of patients and disease characteristics, extent of liver resection, and length of surgery. In LCS Group, blood loss (400 vs. 650 mL, p < 0.001) and rate of intraoperative transfusions (19.3 vs. 47.2 %, p = 0.04) were lower compared to TOS Group. LCS Group was associated with reduced postoperative morbidity (24.6 vs. 44.4 %, p = 0.039), and shorter postoperative median hospital stay (9 vs. 13 days, p < 0.001). LCS and TOS Groups had comparable oncologic radicality in terms of primary tumor lymphadenectomy (median number of removed nodes 19 and 20, respectively, p NS) and rate of R1 colorectal resections (two patients in both Groups). Multivariate analysis revealed significant correlation morbidity with preoperative chemotherapy, blood loss, and approach to primary tumor.
  
  
  CONCLUSIONS
  Laparoscopic resection of colorectal cancer in patients undergoing simultaneous open resection of liver metastases is associated with a reduction of blood loss, morbidity, and postoperative hospital stay, without affecting oncologic radicality. Outcome is mainly conditioned by approach to intestinal surgery, rather than the extent of liver resection.
authors.affiliation: Hepatobiliary Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy, ratti.francesca@hsr.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ratti
authors.forename: Marco
authors.initials: M
authors.lastname: Catena
authors.forename: Saverio
authors.initials: S
authors.lastname: Di Palo
authors.forename: Carlo
authors.initials: C
authors.lastname: Staudacher
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D061646:Operative Time; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome