Laparoscopic Approach for Primary Colorectal Cancer Improves Outcome of Patients Undergoing Combined Open Hepatic Resection for Liver Metastases

Francesca Ratti, Marco Catena, Saverio Di Palo, Carlo Staudacher, Luca Aldrighetti

Research output: Contribution to journalArticle

9 Citations (Scopus)

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. Study design: 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.

Original languageEnglish
Pages (from-to)2573-2582
Number of pages10
JournalWorld Journal of Surgery
Volume39
Issue number10
DOIs
Publication statusPublished - Oct 1 2015

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Colorectal Neoplasms
Neoplasm Metastasis
Liver
Liver Neoplasms
Morbidity
Length of Stay
Postoperative Hemorrhage
Neoplasms
Colorectal Surgery
Rectal Neoplasms
Lymph Node Excision
Laparoscopy
Colonic Neoplasms
Laparotomy
Multivariate Analysis
Safety
Drug Therapy

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic Approach for Primary Colorectal Cancer Improves Outcome of Patients Undergoing Combined Open Hepatic Resection for Liver Metastases. / Ratti, Francesca; Catena, Marco; Di Palo, Saverio; Staudacher, Carlo; Aldrighetti, Luca.

In: World Journal of Surgery, Vol. 39, No. 10, 01.10.2015, p. 2573-2582.

Research output: Contribution to journalArticle

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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. Study design: 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.",
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T1 - Laparoscopic Approach for Primary Colorectal Cancer Improves Outcome of Patients Undergoing Combined Open Hepatic Resection for Liver Metastases

AU - Ratti, Francesca

AU - Catena, Marco

AU - Di Palo, Saverio

AU - Staudacher, Carlo

AU - Aldrighetti, Luca

PY - 2015/10/1

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N2 - 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. Study design: 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.

AB - 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. Study design: 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.

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