Zhu D X, He G D, Mao Y H, Wei Y, Ren L, Lin Q, Wang X Y, Xu J M
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Liver Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Jun 25;23(6):584-588. doi: 10.3760/cma.j.cn.441530-20200412-00197.
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). 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. 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. 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.
探讨可切除性同步结直肠癌肝转移（SCRLM）患者行腹腔镜同期切除原发性结直肠癌和肝转移灶的短期疗效。进行了一项描述性病例系列研究。从前瞻性结直肠癌数据库中检索2015年12月至2018年9月在中山医院接受腹腔镜同期切除结直肠癌和肝转移灶的SCRLM患者的临床病理数据。分析围手术期表现和短期疗效。共纳入53例患者，平均年龄（61.7±11.3）岁。其中，男性32例（60.4%），女性21例（39.6%）。25例（47.2%）美国麻醉医师协会（ASA）分级为I级，28例（52.8%）为II级。所有患者均顺利完成腹腔镜同期切除，无中转开腹。平均手术时间为（320.2±114.5）分钟。估计失血量为150.0（45.0 - 2000.0）毫升，仅2例（3.8%）患者术中输血。术后病理结果显示，原发性肿瘤平均大小为（5.4±1.9）厘米；4例（7.5%）为T1 - 2期，48例（90.6%）为T3 - 4期；40例患者（75.5%）有淋巴结转移；19例（35.8%）有血管侵犯；24例（45.3%）有神经侵犯。肝转移灶中位数为1.0（1 - 8）个，最大肝转移灶平均大小为（3.0±1.9）厘米。肝转移灶切缘中位数为1.0（0.1 - 3.5）厘米，仅1例为R1切除。术后首次排气平均时间为（67.9±28.9）小时，开始进流食平均时间为（107.0±33.8）小时。术后平均留置导尿时间为（85.6±56.4）小时。术后平均住院时间为（9.2±4.4）天，平均费用为（82±26）千元人民币。术后30天内无死亡病例。术后并发症发生率为32.1%（17/53），3例患者出现III至IV级并发症，经保守治疗后好转。中位随访期为23.2个月。随访期间，19例患者（35.8%）出现复发或转移，4例（7.5%）死亡。1年和2年无病生存率（DFS）分别为68%和47%，1年和2年总生存率分别为95%和86%。对于选定的SCRLM患者，腹腔镜同期切除原发性结直肠癌和肝转移灶是安全可行的。术后肠道功能恢复加快，并发症发生率和肿瘤学结局均可接受。
