Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases

Abstract

Synchronous colorectal carcinoma (SCRC) indicates more than one primary colorectal carcinoma (CRC) discovered at the time of initial presentation, accounts for 3.1%-3.9% of CRC, and may occur either in the same or in different colorectal segments. The accurate preoperative diagnosis of SCRC is difficult and diagnostic failures may lead to inappropriate treatment and poorer prognosis. SCRC requires colorectal resections tailored to individual patients, based on the number, location, and stage of the tumours, from conventional or extended hemicolectomies to total colectomy or proctocolectomy, when established predisposing conditions exist. The overall perioperative risks of surgery for SCRC seem to be higher than for solitary CRC. Simultaneous colorectal and liver resection represents an appealing surgical strategy in selected patients with CRC and synchronous liver metastases (CRLM), even though the cumulative risks of the two procedures need to be adequately evaluated. Simultaneous resections have the noticeable advantage of avoiding a second laparotomy, give the opportunity of an earlier initiation of adjuvant therapy, and may significantly reduce the hospital costs. Because an increasing number of recent studies have shown good results, with morbidity, perioperative hospitalization, and mortality rates comparable to staged resections, simultaneous procedures can be selectively proposed even in case of complex colorectal resections, including those for SCRC and rectal cancer. However, in patients with multiple bilobar CRLM, major hepatectomies performed simultaneously with colorectal resection have been associated with significant perioperative risks. Conservative or parenchymal-sparing hepatectomies reduce the extent of hepatectomy while preserving oncological radicality, and may represent the best option for selected patients with multiple CRLM involving both liver lobes. Parenchymal-sparing liver resection, instead of major or two-stage hepatectomy for bilobar disease, seemingly reduces the overall operative risk of candidates to simultaneous colorectal and liver resection, and may represent the most appropriate surgical strategy whenever possible, also for patients with advanced SCRC and multiple bilobar liver metastases.

Simultaneous Approach of Colo-Rectal and Hepatic Lesions in Colo-Rectal Cancers With Liver Metastasis – A Single Oncological Center Overview

“…In this regard, a recent study conducted in 2021 by Dyre Kleive et al [15], states that simultaneous colorectal and hepatic resection should be avoided when major resections are required, both hepatic and colo-rectal and should be further subject of clinical trials. It is clear that a good postoperative prognostic factor in the simultaneous approach is the size of liver metastases and the extent of liver resection, confirmed in most studies [16,17,18,19].…”

Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases: Between conventional and mini-invasive approaches

“…Altogether, these data demonstrate that CRLM may be well-circumscribed, with a very low incidence of satellite nodules or micrometastases, suggesting a limited effect of minimal negative RM on recurrence or survival rates in selected patients[ 6 , 24 ]. Pawlik et al[ 134 ] have reported that OS and DFS, overall recurrence risk and site of recurrence were similar after resection of CRLM with margins of 1-4 mm, 5-9 mm, and ≥ 10 mm, suggesting that a predicted RM of < 1 cm should not contraindicate liver surgery.…”

“…A complete response of the rectal tumour to CHRT after initial liver surgery has been occasionally described, thus delaying or even avoiding the planned rectal resection[ 78 ]. However, simultaneous colorectal and liver resection represents the most attractive strategy, with growing consensus and a progressive expansion of resectability criteria[ 6 , 28 ]. Simultaneous resections improve the patient experience, by reducing the number of surgical procedures and also the duration of perioperative CHT in selected cases[ 4 , 17 ], and may substantially decrease the cumulative costs of hospitalization[ 79 ].…”

“…Colorectal cancer (CRC) is a very common cause of cancer-related death in developed countries, with synchronous liver metastases (SCRLM) in about 15 to 25% of patients at the time of diagnosis[ 1 , 2 ]. Radical liver resection (LR) of colorectal liver metastases (CRLM) may achieve 5-year overall survival (OS) rates of 37% to 58%[ 3 - 6 ]. However, the expanding availability of therapeutic tools, that include medical, radiological and surgical treatments, alone or in combination, has made the management of metastatic CRC increasingly complex[ 7 , 8 ].…”

“…Repeat LR of CRLM has a well-demonstrated potential for cure in selected patients with recurrent disease[ 29 , 30 ]. In the last decade liver surgery for CRLM has progressively shifted toward more conservative procedures that result in decreased morbidity and mortality rates than major LR, with comparable oncological results[ 6 , 31 - 33 ].…”