Effect of simultaneous laparoscopic surgery in treatment of synchronous colorectal cancer liver metastasis: a retrospective cohort study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Yang ¹ , ZHENG Zhaoyang ¹ , CHEN Peng ¹ ,  FENG Xi ^2,3 , WEI Yonggang ^2,3 ,  YANG Lie ^1,3 , ZHOU Zongguang ^1,3

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Division of Hepatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Institute of Digestive Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

FENG Xi, Email: fengxi@wchscu.edu.cn; YANG Lie, Email: lie_222@163.com

Keywords：

colorectal cancer; synchronous liver metastasis; laparoscopic surgery; simultaneous resection

DOI：

10.7507/1007-9424.202402020

Video：

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Objective To explore the security and feasibility of simultaneous laparoscopic surgery for synchronous colorectal cancer liver metastasis (SCRLM). Method The data of 36 patients underwent simultaneous surgery for SCRLM in the Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University from March 2015 to December 2021 were retrospectively collected, and the perioperative outcomes, postoperative morbidity and survival were analyzed. Results The surgical procedure of all 36 enrolled patients were accomplished. The operation time was (328.9±85.8) min. The intraoperative blood loss was 100 (50, 150) mL and 4 cases (11.1%) needed intraoperative transfusion. The time to first flatus was (2.9±0.8) d and the time to liquid diet was (3.2±1.0) d. The average postoperative VAS score was 1.9±0.3. The postoperative length of stay was (6.8±4.3) d, 5 (13.9%) cases developed postoperative complications, which were cured by conservative treatment. No severe complications and death occurred within 30 days after surgery. After a median follow-up of 24.7 months, 15 cases (41.7%) experienced recurrence or metastasis and 1 case (2.8%) died. The 1-, 2- and 3-year disease-free survival rates were 89.8%, 55.0%, 29.2%, respectively. The 1-, 2- and 3-year overall survival rates were 100.0%, 100.0%, 87.5%, respectively. There was no significant differences in disease-free survival rates (χ²=1.675, P=0.196) and OS (χ²=0.600, P=0.439) between patients with (n=26) or without (n=10) neoadjuvant. Conclusions Simultaneous laparoscopic surgery seems to be a secure and feasible strategy for patients with SCRLM, with considerable survival benefits and short-term outcomes including small incision, little bleeding, quick recovery and low complication rate. More high-quality clinical studies are desirable in the future to further confirm the efficacy and safety of this operation.

Citation： YANG Yang, ZHENG Zhaoyang, CHEN Peng, FENG Xi, WEI Yonggang, YANG Lie, ZHOU Zongguang. Effect of simultaneous laparoscopic surgery in treatment of synchronous colorectal cancer liver metastasis: a retrospective cohort study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(5): 547-554. doi: 10.7507/1007-9424.202402020 Copy

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	中国医师协会外科医师分会, 中华医学会外科学分会胃肠外科学组, 中华医学会外科学分会结直肠外科学组, 等. 中国结直肠癌肝转移诊断和综合治疗指南 (2023). 中国临床医学, 2023, 30(1): 166-198.
3.	Albertsmeier M, Riedl K, Stephan AJ, et al. Improved survival after resection of colorectal liver metastases in patients with unresectable lung metastases. HPB (Oxford), 2020, 22(3): 368-375.
4.	Endo Y, Alaimo L, Araujo Lima H, et al. Simultaneous versus staged resection for synchronous colorectal liver metastases: the win ratio approach. Am J Surg, 2023, 225(3): 461-465.
5.	Wang SH, Song L, Tang JY, et al. Safety and long-term prognosis of simultaneous versus staged resection in synchronous colorectal cancer with liver metastasis: a systematic review and meta-analysis. Eur J Med Res, 2022, 27(1): 297. doi: 10.1186/s40001-022-00937-z.
6.	Gumiero JL, Oliveira BMS, Neto PAO, et al. Timing of resection of synchronous colorectal liver metastasis: a systematic review and meta-analysis. J Surg Oncol, 2022, 126(1): 175-188.
7.	Wu Y, Mao A, Wang H, et al. Association of simultaneous vs delayed resection of liver metastasis with complications and survival among adults with colorectal cancer. JAMA Netw Open, 2022, 5(9): e2231956. doi: 10.1001/jamanetworkopen.2022.31956.
8.	中国研究型医院学会微创外科学专业委员会. 结直肠癌肝转移腹腔镜/机器人同期联合切除技术指南 (2017修订). 临床肝胆病杂志, 2018, 34(3): 494-497.
9.	Vreeland TJ, Collings AT, Ozair A, et al. SAGES/AHPBA guidelines for the use of minimally invasive surgery for the surgical treatment of colorectal liver metastases (CRLM). Surg Endosc, 2023, 37(4): 2508-2516.
10.	中华人民共和国国家卫生健康委员会, 中华医学会肿瘤学分会. 中国结直肠癌诊疗规范 (2023年版). 中华外科杂志, 2023, 61(8): 617-644.
11.	Kron P, Linecker M, Jones RP, et al. Ablation or resection for colorectal liver metastases? A systematic review of the literature. Front Oncol, 2019, 9: 1052. doi: 10.3389/fonc.2019.01052.
12.	Imai K, Allard MA, Castro Benitez C, et al. Long-term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases. Br J Surg, 2017, 104(5): 570-579.
13.	Sabiston DC. Sabiston textbook of surgery. 20 ed. Amsterdam: Elsevier, 2016.
14.	Adam R, de Gramont A, Figueras J, et al. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev, 2015, 41(9): 729-741.
15.	Siriwardena AK, Serrablo A, Fretland ÅA, et al. The multi-societal European consensus on the terminology, diagnosis and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE. HPB (Oxford), 2023, 25(9): 985-999.
16.	Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet, 2008, 371(9617): 1007-1016.
17.	Sonbol MB, Siddiqi R, Uson PLS, et al. The role of systemic therapy in resectable colorectal liver metastases: systematic review and network meta-analysis. Oncologist, 2022, 27(12): 1034-1040.
18.	Allard MA, Nishioka Y, Beghdadi N, et al. Multicentre study of perioperative versus adjuvant chemotherapy for resectable colorectal liver metastases. BJS Open, 2019, 3(5): 678-686.
19.	Ayez N, van der Stok EP, Grünhagen DJ, et al. The use of neo-adjuvant chemotherapy in patients with resectable colorectal liver metastases: clinical risk score as possible discriminator. Eur J Surg Oncol, 2015, 41(7): 859-867.
20.	Lillemoe HA, Vauthey JN. Surgical approach to synchronous colorectal liver metastases: staged, combined, or reverse strategy. Hepatobiliary Surg Nutr, 2020, 9(1): 25-34.
21.	Boudjema K, Locher C, Sabbagh C, et al. Simultaneous versus delayed resection for initially resectable synchronous colorectal cancer liver metastases: a prospective, open-label, randomized, controlled trial. Ann Surg, 2021, 273(1): 49-56.
22.	Gavriilidis P, Katsanos K, Sutcliffe RP, et al. Simultaneous, delayed and liver-first hepatic resections for synchronous colorectal liver metastases: a systematic review and network meta-analysis. J Clin Med Res, 2019, 11(8): 572-582.
23.	Giuliante F, Viganò L, De Rose AM, et al. Liver-first approach for synchronous colorectal metastases: analysis of 7 360 patients from the Livermetsurvey Registry. Ann Surg Oncol, 2021, 28(13): 8198-8208.
24.	Creavin B, Kelly ME, Ryan ÉJ, et al. Oncological outcomes of laparoscopic versus open rectal cancer resections: meta-analysis of randomized clinical trials. Br J Surg, 2021, 108(5): 469-476.
25.	Jadid KD, Cao Y, Petersson J, et al. Long-term oncological outcomes for minimally invasive surgery versus open surgery for colon cancer-a population-based nationwide study with a non-inferiority design. Colorectal Dis, 2023, 25(5): 954-963.
26.	Zhang XL, Liu RF, Zhang D, et al. Laparoscopic versus open liver resection for colorectal liver metastases: a systematic review and meta-analysis of studies with propensity score-based analysis. Int J Surg, 2017, 44: 191-203.
27.	Ozair A, Collings A, Adams AM, et al. Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis. Surg Endosc, 2022, 36(11): 7915-7937.
28.	Morarasu S, Clancy C, Gorgun E, et al. Laparoscopic versus open resection of primary colorectal cancers and synchronous liver metastasis: a systematic review and meta-analysis. Int J Colorectal Dis, 2023, 38(1): 90. doi: 10.1007/s00384-023-04375-z.
29.	Liu M, Wang Y, Wang K, et al. Combined ablation and resection (CARe) for resectable colorectal cancer liver metastases-a propensity score matching study. Eur J Surg Oncol, 2023, 49(9): 106931.
30.	Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, et al. Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg, 2018, 267(2): 199-207.
31.	Berardi G, Igarashi K, Li CJ, et al. Parenchymal sparing anatomical liver resections with full laparoscopic approach: description of technique and short-term results. Ann Surg, 2021, 273(4): 785-791.
32.	Chen YW, Huang MT, Chang TC. Long term outcomes of simultaneous laparoscopic versus open resection for colorectal cancer with synchronous liver metastases. Asian J Surg, 2019, 42(1): 217-223.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. 中国医师协会外科医师分会, 中华医学会外科学分会胃肠外科学组, 中华医学会外科学分会结直肠外科学组, 等. 中国结直肠癌肝转移诊断和综合治疗指南 (2023). 中国临床医学, 2023, 30(1): 166-198.
3. Albertsmeier M, Riedl K, Stephan AJ, et al. Improved survival after resection of colorectal liver metastases in patients with unresectable lung metastases. HPB (Oxford), 2020, 22(3): 368-375.
4. Endo Y, Alaimo L, Araujo Lima H, et al. Simultaneous versus staged resection for synchronous colorectal liver metastases: the win ratio approach. Am J Surg, 2023, 225(3): 461-465.
5. Wang SH, Song L, Tang JY, et al. Safety and long-term prognosis of simultaneous versus staged resection in synchronous colorectal cancer with liver metastasis: a systematic review and meta-analysis. Eur J Med Res, 2022, 27(1): 297. doi: 10.1186/s40001-022-00937-z.
6. Gumiero JL, Oliveira BMS, Neto PAO, et al. Timing of resection of synchronous colorectal liver metastasis: a systematic review and meta-analysis. J Surg Oncol, 2022, 126(1): 175-188.
7. Wu Y, Mao A, Wang H, et al. Association of simultaneous vs delayed resection of liver metastasis with complications and survival among adults with colorectal cancer. JAMA Netw Open, 2022, 5(9): e2231956. doi: 10.1001/jamanetworkopen.2022.31956.
8. 中国研究型医院学会微创外科学专业委员会. 结直肠癌肝转移腹腔镜/机器人同期联合切除技术指南 (2017修订). 临床肝胆病杂志, 2018, 34(3): 494-497.
9. Vreeland TJ, Collings AT, Ozair A, et al. SAGES/AHPBA guidelines for the use of minimally invasive surgery for the surgical treatment of colorectal liver metastases (CRLM). Surg Endosc, 2023, 37(4): 2508-2516.
10. 中华人民共和国国家卫生健康委员会, 中华医学会肿瘤学分会. 中国结直肠癌诊疗规范 (2023年版). 中华外科杂志, 2023, 61(8): 617-644.
11. Kron P, Linecker M, Jones RP, et al. Ablation or resection for colorectal liver metastases? A systematic review of the literature. Front Oncol, 2019, 9: 1052. doi: 10.3389/fonc.2019.01052.
12. Imai K, Allard MA, Castro Benitez C, et al. Long-term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases. Br J Surg, 2017, 104(5): 570-579.
13. Sabiston DC. Sabiston textbook of surgery. 20 ed. Amsterdam: Elsevier, 2016.
14. Adam R, de Gramont A, Figueras J, et al. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev, 2015, 41(9): 729-741.
15. Siriwardena AK, Serrablo A, Fretland ÅA, et al. The multi-societal European consensus on the terminology, diagnosis and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE. HPB (Oxford), 2023, 25(9): 985-999.
16. Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet, 2008, 371(9617): 1007-1016.
17. Sonbol MB, Siddiqi R, Uson PLS, et al. The role of systemic therapy in resectable colorectal liver metastases: systematic review and network meta-analysis. Oncologist, 2022, 27(12): 1034-1040.
18. Allard MA, Nishioka Y, Beghdadi N, et al. Multicentre study of perioperative versus adjuvant chemotherapy for resectable colorectal liver metastases. BJS Open, 2019, 3(5): 678-686.
19. Ayez N, van der Stok EP, Grünhagen DJ, et al. The use of neo-adjuvant chemotherapy in patients with resectable colorectal liver metastases: clinical risk score as possible discriminator. Eur J Surg Oncol, 2015, 41(7): 859-867.
20. Lillemoe HA, Vauthey JN. Surgical approach to synchronous colorectal liver metastases: staged, combined, or reverse strategy. Hepatobiliary Surg Nutr, 2020, 9(1): 25-34.
21. Boudjema K, Locher C, Sabbagh C, et al. Simultaneous versus delayed resection for initially resectable synchronous colorectal cancer liver metastases: a prospective, open-label, randomized, controlled trial. Ann Surg, 2021, 273(1): 49-56.
22. Gavriilidis P, Katsanos K, Sutcliffe RP, et al. Simultaneous, delayed and liver-first hepatic resections for synchronous colorectal liver metastases: a systematic review and network meta-analysis. J Clin Med Res, 2019, 11(8): 572-582.
23. Giuliante F, Viganò L, De Rose AM, et al. Liver-first approach for synchronous colorectal metastases: analysis of 7 360 patients from the Livermetsurvey Registry. Ann Surg Oncol, 2021, 28(13): 8198-8208.
24. Creavin B, Kelly ME, Ryan ÉJ, et al. Oncological outcomes of laparoscopic versus open rectal cancer resections: meta-analysis of randomized clinical trials. Br J Surg, 2021, 108(5): 469-476.
25. Jadid KD, Cao Y, Petersson J, et al. Long-term oncological outcomes for minimally invasive surgery versus open surgery for colon cancer-a population-based nationwide study with a non-inferiority design. Colorectal Dis, 2023, 25(5): 954-963.
26. Zhang XL, Liu RF, Zhang D, et al. Laparoscopic versus open liver resection for colorectal liver metastases: a systematic review and meta-analysis of studies with propensity score-based analysis. Int J Surg, 2017, 44: 191-203.
27. Ozair A, Collings A, Adams AM, et al. Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis. Surg Endosc, 2022, 36(11): 7915-7937.
28. Morarasu S, Clancy C, Gorgun E, et al. Laparoscopic versus open resection of primary colorectal cancers and synchronous liver metastasis: a systematic review and meta-analysis. Int J Colorectal Dis, 2023, 38(1): 90. doi: 10.1007/s00384-023-04375-z.
29. Liu M, Wang Y, Wang K, et al. Combined ablation and resection (CARe) for resectable colorectal cancer liver metastases-a propensity score matching study. Eur J Surg Oncol, 2023, 49(9): 106931.
30. Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, et al. Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg, 2018, 267(2): 199-207.
31. Berardi G, Igarashi K, Li CJ, et al. Parenchymal sparing anatomical liver resections with full laparoscopic approach: description of technique and short-term results. Ann Surg, 2021, 273(4): 785-791.
32. Chen YW, Huang MT, Chang TC. Long term outcomes of simultaneous laparoscopic versus open resection for colorectal cancer with synchronous liver metastases. Asian J Surg, 2019, 42(1): 217-223.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of simultaneous laparoscopic surgery in treatment of synchronous colorectal cancer liver metastasis: a retrospective cohort study

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