Araujo Raphael Leonardo Cunha de, Figueiredo Marleny Novaes, Sanctis Marco Aurélio de, Romagnolo Luís Gustavo Capochin, Linhares Marcelo Moura, Melani Armando Geraldo Franchini, Marescaux Jacques
Department of Digestive Surgery, Hospital do Câncer de Barretos, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil.
Hospital Municipal da Vila Santa Catarina, Universidade Nove de Julho, Sao Paulo, SP, Brazil.
Acta Cir Bras. 2020;35(3):e202000308. doi: 10.1590/s0102-865020200030000008. Epub 2020 May 22.
The benefits of laparoscopic approaches to treat colorectal cancer (CRC) and colorectal liver metastases (CRLM) separately are well established. However, there is no consensus about the optimal timing to approach the primary tumor and CRLM, whether simultaneously or staged. The objective of this review with practical reports is to discuss technical aspects required for patient selection to perform simultaneous laparoscopic approaches for CRC and CRLM.
Literature review of oncological factors associated with patient selection for surgical treatment of CRLM and the use of laparoscopy in those cases, and report of technical aspects for simultaneous CRC and CRLM approaches.
Simultaneous laparoscopic resection has been successful in many series of selected patients, although it seems to be safer to perform minor and major liver resection with non-extended colorectal resections, and to avoid two high-risk procedures at the same time.
Simultaneous CRC and CRLM resections seem to be safe when patients are carefully selected, also considering the risk of recurrence concerning oncologic outcomes. The pre-planning of simultaneous resection is mandatory to plan trocar positioning, procedure sequencing, and patient position.
腹腔镜方法分别治疗结直肠癌（CRC）和结直肠癌肝转移（CRLM）的益处已得到充分证实。然而，对于处理原发性肿瘤和CRLM的最佳时机，无论是同时进行还是分期进行，尚无共识。本综述结合实际报告的目的是讨论为同时进行CRC和CRLM的腹腔镜手术而进行患者选择所需的技术方面。
对与CRLM手术治疗患者选择相关的肿瘤学因素以及在这些病例中腹腔镜的使用进行文献综述，并报告同时进行CRC和CRLM手术的技术方面。
在许多系列的选定患者中，同时进行腹腔镜切除已取得成功，尽管进行非扩大性结直肠切除的小范围和大范围肝切除似乎更安全，并且要避免同时进行两个高风险手术。
当仔细选择患者时，同时进行CRC和CRLM切除似乎是安全的，同时也要考虑肿瘤学结局方面的复发风险。同时切除的预先规划对于规划套管针定位、手术顺序和患者体位是必不可少的。
