Sharp Grossmont Hospital, La Mesa, CA, USA.
Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA.
Am Surg. 2023 Jun;89(6):2337-2344. doi: 10.1177/00031348221093533. Epub 2022 Apr 29.
Up to 50% of patients with colorectal carcinoma (CRC) present with liver metastases (CLM) throughout their course. Complete resection of both sites provides the only chance for cure. Either a staged or simultaneous resection is feasible. The latter avoids delays in adjuvant systemic chemotherapy but may increase technical complexity and perioperative complications. We aim to evaluate our initial outcomes of simultaneous CRC and CLM resections with a focus on the robotic technique.
With institutional review board approval, we followed 26 consecutive patients who underwent simultaneous/concomitant liver and colorectal resection. Major liver resection is defined as resection of ≥3 contiguous Couinaud segments. Data are presented as median (mean ± SD).
Patients were 64 (63 ± 14.0) years old. Body mass index was 29 (29 ± 5.7) kg/m. 54% of patients had prior abdominal operation(s). A majority of patients were >ASA class III (73%), underwent major liver resection (62%) with robotic approach (77%). In the robotic cohort, there were no unplanned conversions to open. Estimated blood loss was 150 (210 ± 181.8) ml. Total operative duration was 446 (463 ± 93.6) minutes. Negative margins (R0) were obtained in all patients. Postoperative complication of Clavien-Dindo≥3 occurred in three patients, including one requiring reoperation with end ileostomy for anastomotic leak. Length of stay was 5 (6 ± 3.5) days. Three patients were readmitted within 30 days after discharge, none for reoperation. There was no 90-day mortality.
Our cohort of concomitant CRC and CLM resection demonstrates safety and efficacy via both the open and robotic approach.
多达 50%的结直肠癌（CRC）患者在其病程中出现肝转移（CLM）。完全切除两个部位是治愈的唯一机会。分期或同时切除都是可行的。后者避免了辅助系统化疗的延迟，但可能增加技术复杂性和围手术期并发症。我们旨在评估同时进行 CRC 和 CLM 切除术的初始结果，重点关注机器人技术。
在机构审查委员会批准下，我们随访了 26 例连续接受同时/伴随肝和结直肠切除术的患者。主要肝切除术定义为切除≥3 个连续的 Couinaud 段。数据以中位数（均值±标准差）表示。
患者年龄为 64 岁（63±14.0）岁。体重指数为 29kg/m²（29±5.7kg/m²）。54%的患者有过腹部手术史。大多数患者>ASA 分级 III 级（73%），采用主要肝切除术（62%）和机器人方法（77%）。在机器人组中，没有计划转为开放手术。估计失血量为 150ml（210±181.8ml）。总手术时间为 446 分钟（463±93.6 分钟）。所有患者均获得阴性切缘（R0）。术后并发症 Clavien-Dindo≥3 级发生在 3 例患者中，其中 1 例因吻合口漏需行回肠造口术再次手术。住院时间为 5 天（6±3.5 天）。3 例患者在出院后 30 天内再次入院，但均无需再次手术。无 90 天死亡。
我们的同时进行 CRC 和 CLM 切除术队列通过开放和机器人方法均显示出安全性和有效性。
