Simultaneous Minimally Invasive Treatment of Colorectal Neoplasm with Synchronous Liver Metastasis.
Purpose. To analyse perioperative and oncological outcomes of minimally invasive simultaneous resection of primary colorectal neoplasm with synchronous liver metastases. Methods. A Medline revision of the current published literature on laparoscopic and robotic-assisted combined colectomy with hepatectomy for synchronous liver metastatic colorectal neoplasm was performed until February 2015. The specific search terms were "liver metastases", "hepatic metastases", "colorectal", "colon", "rectal", "minimally invasive", "laparoscopy", "robotic-assisted", "robotic colorectal and liver resection", "synchronous", and "simultaneous". Results. 20 clinical reports including 150 patients who underwent minimally invasive one-stage procedure were retrospectively analysed. No randomized trials were found. The approach was laparoscopic in 139 patients (92.7%) and robotic in 11 cases (7.3%). The rectum was the most resected site of primary neoplasm (52.7%) and combined liver procedure was in 89% of cases a minor liver resection. One patient (0.7%) required conversion to open surgery. The overall morbidity and mortality rate were 18% and 1.3%, respectively. The most common complication was colorectal anastomotic leakage. Data concerning oncologic outcomes were too heterogeneous in order to gather definitive results. Conclusion. Although no prospective randomized trials are available, one-stage minimally invasive approach seems to show advantages over conventional surgery in terms of postoperative short-term course. On the contrary, more studies are required to define the oncologic values of the minimally invasive combined treatment.
General and Reconstructive Surgery, Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy.
Stefano
S
Garritano
Division of Surgery, Casa di Cura Villa Serena, Città Sant'Angelo, 65013 Pescara, Italy.
Federico
F
Selvaggi
HPB and Advanced Minimally Invasive Liver Surgical Unit, Department of General and Minimally Invasive Surgery, Policlinico Abano Terme, 1 Cristoforo Colombo Square, Abano Terme, 35031 Padua, Italy.
Marcello Giuseppe
MG
Spampinato
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000401:mortality / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D019317:Evidence-Based Medicine; D006498:Hepatectomy / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome