Laparoscopic synchronous resection of colorectal cancer and liver metastases: A systematic review

Abstract

While colorectal and hepatic resections are commonly performed through a laparoscopic approach, the safety and feasibility of total laparoscopic synchronous resections (LSR) of colorectal liver metastasis (CRLM) have not been established. In this systematic review, short-and long-term outcomes were comparable for patientsundergoing LSR and open synchronous resection. LSR was safe and feasible for patients with synchronous CRLM and should be considered in well-selected patients. K E Y W O R D S colorectal cancer, combined resection, laparoscopy, liver metastasis, synchronous resection 1 | INTRODUCTION Colorectal cancer (CRC) is the third leading cause of cancerrelated deaths in the United States. In 2017, approximately 140 000 new cases of CRC were diagnosed with over 50 000 cancer-related deaths. 1 The liver is the most common site of metastases with 15% to 25% of patients presenting with synchronous colorectal liver metastases (CRLM) at the time of diagnosis. 2,3 Modern chemotherapy has resulted in improved response and survival rates for patients with liver metastases and has also increased the rate of resectability of CRLM in selected patients as part of a comprehensive multidisciplinary treatment strategy. In turn, resection of CRLM is now associated with 5-year survival greater than 50%. 4,5Among patients with resectable disease, surgical resection remains the only potentially curative treatment for synchronous CRLM. 4 However, the optimal operative sequence for the management of the primary tumor and metastatic liver disease remains unclear. 6 The traditional surgical strategy consists of a staged approach, in which resection of the primary tumorwith or without adjuvant chemotherapyis followed by a planned liver resection at a future date (colorectal-first approach). Alternatively, the "reverse approach" consists of resection of liver metastases before removal of the primary tumor (liver-first approach). With improvements in surgical technique and perioperative care over the past two decades, an increasing number of patients are being managed through a combined approach comprised of synchronous resection of the primary colorectal tumor and liver metastases. 7,8 Several studies have demonstrated the safety, efficacy, and feasibility of open synchronous resections (OSR), with acceptable morbidity, mortality, and long-term outcomes. 7,9,10 Furthermore, synchronous resection (SR) may offer several potential benefits for patients, including shorter overall hospital LOS, reduced costs, and the need to recover from only one major operation, while providing equivalent oncologic outcomes. 11,12 J Surg Oncol. 2019;119:30-39. wileyonlinelibrary.com/journal/jso 30 |

Laparoscopic procedure is associated with lower morbidity for simultaneous resection of colorectal cancer and liver metastases: an updated meta-analysis

“…More importantly, CRC is an extraordinary progressive cancer, and many patients have metastatic lesions at the time of initial diagnosis. Liver is the primary metastatic site for patients with CRC and 15–20% of those patients presenting with synchronous colorectal liver metastases (SCRLM) [ 5 ]. These can be resected in one operation or as staged approach, depending on the complexity of the hepatectomy and colectomy, comorbid diseases, and surgeon expertise [ 6 , 7 ].…”

Synchronous Liver Metastases from Colorectal Cancer: State of the Art

“…The liver is the dominant metastatic site for patients with CRC, and approximately 50% of patients develop liver metastases (CRCLM) during the course of their disease; 15% to 25% of patients, present with synchronous CRCLM at the time of diagnosis, only a small number of patients can be suitable for upfront surgery (3)(4)(5)(6).…”

“…If it becomes resectable, we prefer the reverse approach to surgery (liver first). For rectal cancer, we usually start with chemotherapy, then radiotherapy and, in the window between irradiation and rectal cancer surgery, we perform the resection of the CRCLM (4)(5)(6)8,18,19,23).…”

“…For patients with symptomatic CRC and resectable synchronous CRCLM, we prefer to adopt resection of the primary tumor for perforated or occlusive tumours, followed by chemotherapy (short period, 3 cycles) and then surgery for CRCLM. However, this is not suitable for tumors with bleeding causing anaemia, for patients treated with transfusions or for those with a good response after chemotherapy (4)(5)(6)8,18,19,23).…”

“…This treatment is proceeded by conversion chemotherapy and, then, surgery for CRCLM if, after revaluation the resectability is achieved. (4)(5)(6)8,18,19,23).…”