title: Laparoscopic combined colorectal and liver resections for primary colorectal cancer with synchronous liver metastases.
abstract: OBJECTIVE
  Synchronous liver metastases (SLMs) are found in 15-25% of patients at the time of diagnosis with colorectal cancer, which is limited to the liver in 30% of patients. Surgical resection is the most effective and potentially curative therapy for metastatic colorectal carcinoma (CRC) of the liver. The comparison of simultaneous resection of primary CRC and synchronous liver metastases with staged resections is the subject of debate with respect to morbidity. Laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens hospitalization, and yields superior cosmetic results, without compromising the oncological outcome. The aim of this study is therefore to evaluate our initial experience with simultaneous laparoscopic resection of primary CRC and SLM.
  
  
  METHODS
  Currently, laparoscopic resection of primary CRC is performed in more than 53% of all patients in our surgical department. Twenty-six patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. Six of them underwent laparoscopic colorectal resection combined with major laparoscopic liver resection.
  
  
  RESULTS
  The surgical approaches were total laparoscopic (25 patients) or hybrid technique (1 patients). The incision created for the extraction of the specimen varied between 5 and 8cm. The median operation time was 223 minutes (100 to 415 min.) with a total blood loss of 180 ml (100-300 ml). Postoperative hospital stay was 6.8 days (6-14 days). Postoperative complications were observed in 6 patients (22.2%).
  
  
  CONCLUSIONS
  Simultaneous laparoscopic colorectal and liver resection appears to be safe, feasible, and with satisfying short-term results in selected patients with CRC and SLM.
authors.affiliation: Clinic of Hepato-pancreato-biliary Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria.
authors.forename: Ivelin
authors.initials: I
authors.lastname: Takorov
authors.affiliation: Surgical Department, Eurohospital, Plovdiv, Bulgaria.
authors.forename: Nikolay
authors.initials: N
authors.lastname: Belev
authors.affiliation: Clinic of Hepato-pancreato-biliary Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria.
authors.forename: Tsonka
authors.initials: T
authors.lastname: Lukanova
authors.affiliation: Surgical Department, Eurohospital, Plovdiv, Bulgaria.
authors.forename: Boiko
authors.initials: B
authors.lastname: Atanasov
authors.affiliation: Surgical Department, Eurohospital, Plovdiv, Bulgaria.
authors.forename: Georgi
authors.initials: G
authors.lastname: Dzharov
authors.affiliation: Surgical Department, Eurohospital, Plovdiv, Bulgaria.
authors.forename: Ventzeslav
authors.initials: V
authors.lastname: Djurkov
authors.affiliation: Department of Anesthesiology and Intensive Care, Military Medical Academy, Sofia, Bulgaria.
authors.forename: Evelina
authors.initials: E
authors.lastname: Odisseeva
authors.affiliation: Clinic of Hepato-pancreato-biliary Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria.
authors.forename: Nikola
authors.initials: N
authors.lastname: Vladov
keywords: Colorectal cancer; Major laparoscopic liver resections; Simultaneous laparoscopic colorectal and liver resections; Synchronous colorectal liver metastases