Simultaneous pure laparoscopic resection of primary colorectal cancer and synchronous liver metastases: a single institution experience with propensity score matching analysis
, , , , und | 01. Nov. 2017
Über diesen Artikel
Article Category: Research Article
Online veröffentlicht: 01. Nov. 2017
Seitenbereich: 42 - 53
Eingereicht: 08. Sept. 2017
Akzeptiert: 08. Okt. 2017
DOI: https://doi.org/10.1515/raon-2017-0047
© 2018 Arpad Ivanecz, Bojan Krebs, Andraz Stozer, Tomaz Jagric, Irena Plahuta, Stojan Potrc
This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Postoperative outcome: patient’s recovery, morbidity and mortality. No postoperative mortality occurred in either group. Adjuvant chemotherapy and incisional hernias
| Variable | Simultaneous Open | Simultaneous Laparoscopy | P |
|---|---|---|---|
| (n = 10) | (n = 10) | ||
| ICU stay | 0 | 0 | – |
| HDU stay [median (IQR) (days)] | 4 (2–6) | 3 (2–5) | 0.59 |
| 5.5 (4–6) | 3 (3–4) | ||
| Stool passing [median (IQR) (days)] | 4.5 (4–5) | 4 (3–5) | 0.46 |
| Intravenous narcotics requirement [median (IQR) (days)] | 6.5 (6–7) | 4.5 (3–7) | 0.08 |
| 11.5 (10–33) | 8 (8–12) | ||
| Overall (y/n) | 5/5 | 3/7 | 0.65 |
| Liver specific Liver specific complications included liver failure, bile leak, bile collection or liver hemorrhage; values in bold are significant at P < 0.05 | 2/8 | 0/10 | 0.47 |
| CD < III (y/n) | 2/8 | 2/8 | 1.00 |
| CD IIIab (y/n) | 3/7 | 1/9 | 0.58 |
| CD > III (y/n) | 0/10 | 0/10 | 1.00 |
| 0/10 | 0/10 | 1.00 | |
| Postoperative chemotherapy (y/n) | 5/5 | 2/8 | 0.35 |
| Incisional hernias (y/n) | 3/7 | 0/10 | 0.21 |
Morbidity details, hospital stay, patterns and time of recurrence, redo procedures and long-term outcome.
| Patients | Morbidity | Hospital stay (days) | Recurrence location (years after first surgery) | Redo | Survival (years) | Survival status (March 2017) |
|---|---|---|---|---|---|---|
| OPEN | ||||||
| 1 | Wound infection (CD II) | 12 | 1) Liver (2Y) 2) Liver (3Y) | 1) Liver 2) / | 3 | DOD |
| 2 | Bile collection (CD IIIa) | 36 | Liver (1Y) | Liver | 7 | NED |
| 1) Liver (1Y) | 1) Liver | |||||
| 3 | nil | 9 | 2) Colon (3Y) | 2) Colon | 4 | DOD |
| 3) Peritoneal carcinosis (4Y) | 3) / | |||||
| 4 | Anastomotic leak (CD IIIb) | 54 | Liver (1Y) | Liver | 5 | NED |
| 5 | nil | 10 | no | / | 11 | NED |
| 6 | Pneumonia (CD II) | 12 | no | / | 10 | D - other |
| 7 | nil | 11 | no | / | 8 | NED |
| 8 | nil | 9 | no | / | 8 | NED |
| 9 | Bile collection (CD IIIa) | 33 | no | / | 7 | NED |
| 10 | nil | 10 | no | / | 5 | NED |
| 1 | nil | 8 | no | / | 5 | NED |
| 2 | Anastomotic leak (CD IIIb) | 42 | Liver and peritoneal carcinosis (1Y) | / | 2 | DOD |
| 3 | nil | 7 | no | / | 4 | NED |
| 4 | nil | 7 | Liver and peritoneal carcinosis (3Y) | / | 4 | AWD |
| 5 | nil | 8 | no | / | 2 | NED |
| 6 | nil | 12 | no | / | 2 | NED |
| 7 | nil | 8 | no | / | 1 | NED |
| 8 | Pulmonary embolism (CD II) | 9 | no | / | 1 | NED |
| 9 | nil | 8 | no | / | <1 | NED |
| 10 | Ictus cerebri (CD II) | 21 | no | / | <1 | NED |
Intraoperative - simultaneous liver and colorectal surgery related variables
| Variable | Simultaneous Open | Simultaneous Laparoscopy | P |
|---|---|---|---|
| (n = 10) | (n = 10) | ||
| – | 10 | – | |
| – | 0 | – | |
| Minor/major resection | 10/0 | 10/0 | 1.00 |
| Atypical/ segmentectomy/LLS | 6/2/2 | 5/3/2 | 0.87 |
| Pringle’s maneuver (y/n) | 2/8 | 3/7 | 1.00 |
| Colon/rectal resection | 6/4 | 5/5 | 1.00 |
| Temporary stoma covering low anastomosis (y/n) | 2 in both groups one patient required ileostomy after anastomotic leak | 3 in both groups one patient required ileostomy after anastomotic leak | 1.00 |
| Terminal colostomy (Hartman or APE) | 2/8 | 2/8 | 1.00 |
| 257 ± 66.8 | 261 ± 92.8 | 0.91 | |
| Estimated [median (IQR) (mL)] | 170 (70-230) | 105 (30-180) | 0.23 |
| Hemoglobin drop Hemoglobin drop = Hemoglobin preoperatively - Hemoglobin postoperatively (g/L) | 22.5 (9–28) | 15.5 (9–17) | 0.38 |
| Transfusion required (y/n) | 3/7 | 3/7 | 1.00 |
Preoperative clinical characteristics of patients, primary colorectal tumor and synchronous colorectal liver metastases
| Variable | Simultaneous Open | Simultaneous Laparoscopy | P |
|---|---|---|---|
| (n = 10) | (n = 10) | ||
| Patients | |||
| Gender (male/female) | 6/4 | 6/4 | 1.00 |
| Age [mean ± SD (years)] | 65.4 ± 8.1 | 62.2 ± 7.9 | 0.39 |
| BMI [median (IQR) (kg/m2)] | 24.0 (23.1–25.5) | 26.9 (23.6–32.1) | 0.34 |
| ASA (I /II/III) | 4/3/3 | 5/3/2 | 0.86 |
| 3/7 | 7/3 | 0.18 | |
| 3/7 | 4/6 | 1.00 | |
| 15.2 ± 12.5 | 7.7 ± 7.7 | 0.12 | |
| Right colon/ left colon/ rectum | 3/3/4 | 2/2/6 | 0.67 |
| Number of lesions [median (IQR)] | 1 (1–2) | 1 (1–2) | 0.68 |
| Larger diameter [mean ± SD (cm)] | 2.9 ± 1.5 | 2.0 ± 1.2 | 0.17 |
| Laterality (unilateral /bilateral) | 9/1 | 9/1 | 1.00 |
| Proximity of major vessel [(hilar or hepatic confluence) (y/n)] | 0/10 | 0/10 | 1.00 |
| Location (anterolateral / posterosuperior) | 8/2 | 9/1 | 1.00 |
Postoperative oncological results after patohistology and clinical risk score
| Variable | Simultaneous Open (n = 10) | Simultaneous Laparoscopy (n = 10) | P |
|---|---|---|---|
| Colorectal tumor | |||
| T (T1/T2/T3/T4) | 0/1/8/1 | 0/1/9/0 | 1.00 |
| N (N0/N+) | 2/8 | 2/8 | 1.00 |
| Number of harvested lymph nodes (mean ± SD) | 9.5 ± 6.2 | 13.7 ± 6.9 | 0.17 |
| Well/moderately/poorly differentiated | 4/5/1 | 4/6/0 | 1.00 |
| Liver (y/n) | 10/0 | 10/0 | 1.00 |
| Colorectal (y/n) | 10/0 | 10/0 | 1.00 |
| 2.5 (2–5) | 5.0 (1.8–8) | 0.38 | |
| 2/5/2/1 | 2/4/3/1 | 0.96 | |