Backgrounds/AimsSynchronous 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.MethodsCurrently, 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.ResultsThe 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%).ConclusionsSimultaneous laparoscopic colorectal and liver resection appears to be safe, feasible, and with satisfying short-term results in selected patients with CRC and SLM.

Background Tumours involving the supra‐renal segment of IVC have dismal prognosis if left untreated. Currently, aggressive surgical management is the only potentially curative treatment but is associated with relatively high morbidity and mortality. This study aims to evaluate perioperative factors, associated with adverse postoperative outcomes, based on the perioperative characteristics and type of IVC reconstruction. Methods We identified 44 consecutive patients, who underwent supra‐renal IVC resection with a mean age of 57.3 years. Isolated resection of IVC was performed in four patients, concomitant liver resection was performed in 27 patients and other associated resection in 13 patients. Total vascular exclusion was applied in 21 patients, isolated IVC occlusion in 11 patients. Neither venovenous bypass (VVB) nor hypothermic perfusion was used in any of the cases. Results The mean operative time was 205 min (150–324 min) and the mean estimated blood loss was 755 ml (230–4500 ml). Overall morbidity was 59% and major complications (Dindo‐Clavien ≥ III) occurred in 11 patients (25%). The 90‐day mortality was 11% (5pts). Intraoperative haemotransfusion was significantly associated with postoperative general complications (p < 0,001). With a mean follow‐up of 26.2 months, the actuarial 1‐, 3‐ and 5‐year survival is 69%, 34%, and 16%, respectively. Conclusions IVC resection and reconstruction in the aspect of aggressive surgical management of malignant disease confers a survival advantage in patients, often considered unresectable. When performed in experienced centres it is associated with acceptable morbidity and mortality.

Currently, porto-mesenteric vein resection is a standard procedure at high-volume pancreatic centers. Experience in vascular surgery is indispensable for a modern pancreatic surgeon. Nowadays, only arterial resections still are a controversial issue. Nevertheless, attempts at resection involving reconstruction of the main arteries such as the coeliac axis, hepatic artery, and superior mesenteric artery (SMA) have been reported, although in small case series. An overview of the historical and contemporary methods for surgical management of superior mesenteric/portal vein involvement as well as arterial involvement by pancreatic cancer is presented. We compare the data from the literature with our data based on the examination and long-term follow-up of more than 300 radical pancreatic resections. Seventy-two of the presented patients underwent pancreatic resection with simultaneous vascular resection-SMPV in 65 cases (44 with resection of the portal vein, 15 with resection of the superior mesenteric vein, 6 with resection of the portomesenterial confluence), arterial in 2 and partial resections of IVC in 5 cases. Combined vascular resections were done in three cases. Both groups PVR and PR showed similarly close results in complication rates, mortality, and morbidity. Three and 5 years survival rates were 42 and 38% in PD group and 28 and 19% in the PVR group. The vascular resection must be performed only upon carefully selected patients with data for presence of resectable tumors or tumors with borderline resectability from the preoperative imaging studies. The prompt management of pancreatic cancer with vascular involvement should involve multidisciplinary consultation in high-volume centers.

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