[Efficacy analysis on laparoscopic simultaneous resection of primary colorectal cancer and liver metastases]

Objective: To investigate the short-term outcomes of laparoscopic simultaneous resection of primary colorectal cancer and liver metastases in patients with resectable synchronous colorectal liver metastases (SCRLM). Methods: A descriptive case series study was performed. Clinicopathological data of patients with SCRLM who underwent laparoscopic simultaneous resection of colorectal cancer and liver metastases in Zhongshan Hospital between December 2015 and September 2018 were retrieved from a prospective colorectal cancer database. Perioperative presentations and short-term outcomes were analyzed. Results: A total of 53 patients were enrolled with average age of(61.7±11.3) years. Among them, 32 were male (60.4%) and 21 were female (39.6%). Twenty-five patients (47.2%) were American Society of Anesthesiologists (ASA) grade I and 28 (52.8%) were grade II. All the patients completed laparoscopic simultaneous resection without conversion. The average operation time was (320.2±114.5) min. The estimated blood loss was 150.0 (45.0-2000.0) ml, and only 2 cases (3.8%) received intraoperative transfusion. Postoperative pathologic results revealed that the average primary tumor size was (5.4±1.9) cm; 4 cases (7.5%) were T1-2 stage and 48 cases (90.6%) were T3-4 stage; 40 patients (75.5%) had lymph node metastasis; 19 (35.8%) had vascular involvement; 24 (45.3%) had neural invasion. The median number of liver metastases was 1.0 (1-8), and the average size of largest liver metastases was (3.0±1.9) cm. The median margin of liver metastases was 1.0 (0.1-3.5) cm, and only 1 case was R1 resection. The average time to the first postoperative flatus was (67.9±28.9) h, and the average time to the liquid diet was (107.0±33.8) h. The average postoperative indwelling catheterization time was (85.6±56.4) h. The average postoperative hospital stay was (9.2±4.4) d, and the average cost was (82±26) thousand RMB. No death within postoperative 30-day was found. The morbidity of postoperative complication was 32.1% (17/53) and 3 patients developed grade III to IV complications which were improved by conservative treatment. The median follow-up period was 23.2 months. During follow-up, 19 patients (35.8%) developed recurrence or metastasis, and 4 (7.5%) died. The 1- and 2-year disease-free survival (DFS) rates were 68% and 47% respectively, and the 1- and 2-year overall survival rates were 95% and 86% respectively. Conclusions: Laparoscopic simultaneous resection of primary colorectal cancer and liver metastases is safe and feasible in selected patients with SCRLM. Postoperative intestinal function recovery is enhanced, and morbidity and oncological outcomes are acceptable.

目的： 探讨可切除的同时性结直肠癌肝转移患者接受腹腔镜原发灶和肝转移灶同步切除手术的近期疗效。 方法： 采用描述性病例系列研究方法，从复旦大学附属中山医院前瞻性收集管理的结直肠癌数据库中，选取2015年12月至2018年9月期间接受腹腔镜结直肠癌原发灶和肝转移灶同步切除手术的53例同时性结直肠癌肝转移患者的临床资料，分析围手术期情况及近期疗效。 结果： 全组患者年龄（61.7±11.3）岁，其中男性32例（60.4%），女性21例（39.6%）；美国麻醉医师协会（ASA）评分：Ⅰ级25例（47.2%），Ⅱ级28例（52.8%）。全组患者均顺利完成腹腔镜结直肠原发灶和肝转移灶同步切除手术，无中转开腹者；同步切除的手术时间（320.2±114.5）min。术中失血量150.0（45.0~2000.0）ml，其中仅2例（3.8%）行术中输血。术后病理显示：原发灶肿瘤长径（5.4±1.9）cm；T(1~2)期4例（7.5%），T(3~4)期48例（90.6%）；40例（75.5%）有淋巴结转移；19例（35.8%）有脉管累及，24例（45.3%）有神经侵犯。同步切除肝转移灶中位数1.0（1~8）个，肝转移灶最大径（3.0±1.9）cm，肝转移灶切缘1.0（0.1~3.5）cm，仅1例为R(1)切除。术后首次排气时间（67.9±28.9）h，恢复流质饮食时间为（107.0±33.8）h，术后留置导尿时间（85.6±56.4）h，术后住院时间（9.2±4.4）d，住院费用（8.2±2.6）万元。全组患者均无术后30 d死亡，术后并发症发生率32.1%（17/53），其中Ⅲ~Ⅳ级严重并发症3例。所有并发症均经保守治疗好转。中位随访23.2个月，19例（35.8%）患者发生复发转移，4例（7.5%）死亡。术后1年和2年无病生存率分别为68%和47%，术后1年和2年总体生存率分别为95%和86%。 结论： 腹腔镜同步切除结直肠癌原发灶和肝转移灶在同时性结直肠癌肝转移患者中安全可行，术后胃肠道功能恢复较快，并发症发生率在可接受范围内，肿瘤学结果满意。.

Keywords: Laparoscopic surgery; Simultaneous resection; Synchronous colorectal liver metastasis.