Clinical Impact of Operative Order in Laparoscopic Simultaneous Resection for Synchronous Colorectal Liver Metastases

2021 ◽  
Vol 1 (3) ◽  
pp. 151-156
Author(s):  
TAKUYA TAJIRI ◽  
HIROMITSU HAYASHI ◽  
YUJI MIYAMOTO ◽  
KATSUNORI IMAI ◽  
YUKI KITANO ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Blood Loss ◽  
Liver Metastases ◽  
Surgical Outcomes ◽  
University Hospital ◽  
Operative Blood Loss ◽  
Metastatic Lesions ◽  
Simultaneous Resection ◽  
Significant Difference ◽  
Synchronous Colorectal Liver Metastases

Background: Curative resection for colorectal cancer and their synchronous liver metastases are increasingly performed. However, it is still unclear whether the operative order affects the surgical outcome in laparoscopic simultaneous resection of primary and liver metastatic lesions. Patients and Methods: A total of 27 patients underwent laparoscopic simultaneous resection of primary colorectal cancer and liver metastases at Kumamoto University Hospital. They were divided into two groups based on the order of resection: Colon-first (n=11) and liver-first (n=16) groups. The surgical outcomes between the two groups were retrospectively compared. Results: There was no significant difference in the perioperative surgical outcomes between the two groups except for operative blood loss, which was significantly less in the liver-first group [164 (range=5-820) versus 560 (range=95-2,016) ml, respectively] (p=0.0299). Conclusion: In the simultaneous resection of primary and liver metastatic lesions, the operative order does not affect the short-term surgical outcomes except for operative blood loss.

scholarly journals Nationwide Outcomes of Simultaneous Resection of Primary Colorectal Cancer and Synchronous Liver Metastases

2021 ◽  
Author(s):  
Kara D Bowers ◽  
Allison Rice ◽  
Joshua Parreco ◽  
Alvaro Castillo
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Colon Resection ◽  
Primary Colorectal Cancer ◽  
Total Cost ◽  
Synchronous Liver Metastases ◽  
Simultaneous Resection ◽  
Improved Outcomes ◽  
Significant Difference ◽  
The Us

Abstract Background Of the few studies comparing simultaneous versus staged resection of primary colorectal cancer and synchronous liver metastases, most are limited to resections performed at the same facility. This study was performed to compare outcomes of simultaneous versus staged resection in these patients, including resections performed at a different center. Methods The Nationwide Readmissions Database was queried for all patients undergoing colorectal cancer and metastatic liver resections in the US from 2010 to 2014. Patients undergoing simultaneous resections were compared to patients who underwent liver and colon resections on separate admissions, both liver first and colon first. The outcomes of interest were in-hospital mortality, complications, and total cost. Results During the study period, there were 6,219 patients undergoing resection of primary colorectal cancer and synchronous liver metastases. Separate admission resection was performed at a different hospital in 45.8%. Compared to simultaneous resection, there was a reduced risk for mortality in patients undergoing colon first (OR 0.28, p<0.01) and there was no significant difference in performing liver resection first (OR 0.30, p=0.05). Simultaneous resection was associated with a decreased mean total cost of admissions compared to separate admission resection ($37,278 ±​$34,353 versus $47,985 ​±$​ 28,342, p<0.01). Conclusions Nearly half of separate admission resections of primary colorectal cancer and liver metastases are performed at different hospitals and likely missed by single-center studies. Undergoing colon resection first on a separate admission is costlier, yet patients have more favorable outcomes. Further studies are needed to reveal the underlying factors responsible for these improved outcomes.

Safety and feasibility of laparoscopic surgery for colorectal cancer in elderly patients (YSURG1401 study).

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 725-725
Author(s):  
Yosuke Atsumi ◽  
Masakatsu Numata ◽  
Toru Aoyama ◽  
Tsutomu Hayashi ◽  
Naoto Yamamoto ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Elderly Patients ◽  
Surgical Outcomes ◽  
Operation Time ◽  
University Hospital ◽  
Age Group ◽  
Significant Difference ◽  
Group A ◽  
Group B

725 Background: The safety and feasibility of laparoscopic surgery (LAP) for colorectal cancer has not yet been fully evaluated in elderly patients. The aim of this study was to compare the short term surgical outcomes of LAP and evaluate the safety and feasibility of LAP in colorectal cancer patients aged > 75 years. Methods: This retrospective study enrolled consecutive patients who underwent laparoscopic surgery for colorectal cancer between April 2013 and March 2014 at Yokohama City University Hospital and its related general hospitals. The patients were categorized into two groups: elderly patients (≧75 years of age: group A) and non-elderly patients ( < 75 years of age: group B). Surgical outcomes and postoperative complications were compared between the two groups. The severity of complications was evaluated using the Clavien–Dindo classification. Results: A total of 237 patients were evaluated in the present study. Eighty-four patients were classified into group A, and 153 into group B. Preoperative clinicopathological outcomes demonstrated no significant differences except for the ASA score. When comparing the surgical outcomes between group A and group B, the rate of conversion to open procedure (3.6 % vs 5.2 %, P = 0.751), median operation time (232 min vs 232 min, P = 0.318), median blood loss (20 ml vs 12 ml, P = 0.353). There was no significant difference in the surgical outcomes. Although the incidence of Japanese D3 dissection was significantly lower in Group A (56 % vs 69.3 %, P = 0.047), the incidences of postoperative surgical complications of grade ≧ Ⅱ were similar between two groups (15.5 % vs 11.8 %, p = 0.427). The length of postoperative hospital stay was also similar (10days vs 10days, p = 0.347). Conclusions: The present study suggested that laparoscopic surgery for colorectal cancer is safe and feasible, regardless of the age of the patient, especially for elderly patients who may be candidates for colorectal cancer surgery.

scholarly journals Open Resection Compared to Mini-Invasive in Colorectal Cancer and Liver Metastases: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jie Gong ◽  
Fengwei Gao ◽  
Qingyun Xie ◽  
Xin Zhao ◽  
Zehua Lei
Keyword(s):  
Colorectal Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Liver Metastases ◽  
Invasive Surgery ◽  
Open Surgery ◽  
Colorectal Liver Metastases ◽  
Disease Free Survival ◽  
Simultaneous Resection ◽  
Synchronous Colorectal Liver Metastases

Background: We performed a meta-analysis to evaluate the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases.Methods: A systematic literature search up to April 2021 was done and 13 studies included 1,181 subjects with colorectal cancer and synchronous colorectal liver metastases at the start of the study; 425 of them were using minimally invasive surgery and 756 were open surgery. They were reporting relationships between the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases. We calculated the odds ratio (OR) or the mean difference (MD) with 95% CIs to assess the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases using the dichotomous or continuous method with a random or fixed-effect model.Results: Minimally invasive surgery in subjects with colorectal cancer and synchronous colorectal liver metastases was significantly related to longer operation time (MD, 35.61; 95% CI, 7.36–63.87, p = 0.01), less blood loss (MD, −151.62; 95% CI, −228.84 to −74.40, p &lt; 0.001), less blood transfusion needs (OR, 0.61; 95% CI, 0.42–0.89, p = 0.01), shorter length of hospital stay (MD, −3.26; 95% CI, −3.67 to −2.86, p &lt; 0.001), lower overall complications (OR, 0.59; 95% CI, 0.45–0.79, p &lt; 0.001), higher overall survival (OR, 1.66; 95% CI, 1.21–2.29, p = 0.002), and higher disease-free survival (OR, 1.49; 95% CI, 1.13–1.97, p = 0.005) compared to open surgery.Conclusions: Minimally invasive surgery in subjects with colorectal cancer and synchronous colorectal liver metastases may have less blood loss, less blood transfusion needs, shorter length of hospital stay, lower overall complications, higher overall survival, and higher disease-free survival with longer operation time compared with the open surgery. Furthers studies are required to validate these findings.

scholarly journals Metformin Intake Suppresses The Degree of Liver Metastasis From Colorectal Cancer In Diabetic Patients But Does Not Improve Their Prognosis

2021 ◽  
Author(s):  
Akira Saito ◽  
Joji Kitayama ◽  
Hisanaga Horie ◽  
Koji Koinuma ◽  
Hideyuki Ohzawa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Colorectal Cancer ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Hepatic Metastases ◽  
Stage Iv ◽  
University Hospital ◽  
Diabetic Patients ◽  
Significant Difference ◽  
Patients With Diabetes

Abstract Background: Metformin reduces the risk of, and mortality from, colorectal cancer in patients with diabetes mellitus. However, the effect of metformin on patients with stage IV disease is unknown. In the present study we reviewed the clinical features and outcomes of patients with diabetes mellitus and stage IV colorectal cancer (M1, liver metastases) treated with or without metformin.Methods: The 202 patients with colorectal cancer and macroscopic liver metastasis who were treated in the Department of Surgery or Department of Clinical Oncology at Jichi Medical University Hospital from January 2006 through June 2019 were surveyed treatment of diabetes, clinical and pathological factor and prognosis of these patients. Results: We retrospectively examined the effect of metformin use on outcomes in 32 patients with liver metastases from colorectal cancer. Hepatic metastases were stage H1 in 8/8 patients taking metformin and stage H2-3 in 17/24 non-users. Of 22 patients who underwent colectomy, colorectal tumors were pT4 in 5 metformin users, and pT2-3 in 10/17 non-users. The mean survival of metformin users and non-users was equal (28.0 mo vs 29.3 mo, p>.05). No significant difference was detected when survival was compared between 6 metformin users and 19 non-users who received systemic chemotherapy. Conclusion: These results suggest that metformin has less potent anti-tumor effects in patients with advanced stage disease. Metformin for the treatment of patients with metastatic colorectal cancer requires further study.

scholarly journals Impact of Postoperative Infectious Complications on Long-Term Outcomes for Patients Undergoing Simultaneous Resection for Colorectal Cancer Liver Metastases: A Propensity Score Matching Analysis

2022 ◽  
Vol 11 ◽  
Author(s):  
Qichen Chen ◽  
Yiqiao Deng ◽  
Jinghua Chen ◽  
Jianjun Zhao ◽  
Xinyu Bi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Blood Loss ◽  
Liver Metastases ◽  
Infectious Complications ◽  
Intraoperative Blood Loss ◽  
Long Term Outcomes ◽  
Propensity Score Matching Analysis ◽  
Simultaneous Resection

ObjectiveTo investigate the impact of postoperative infectious complications (POI) on the long-term outcomes of patients with colorectal cancer liver metastasis (CRLM) after simultaneous resection of colorectal cancer and liver metastases.MethodsFour hundred seventy-nine CRLM patients receiving simultaneous resection between February 2010 and February 2018 at our hospital were enrolled. A 1:3 propensity score matching analysis (PSM) analysis was performed to balance covariates and avoid selection bias. After PSM, 90 patients were distributed to the POI group, and 233 patients were distributed to the no POI group. A log-rank test was performed to compare the progression-free survival (PFS) and overall survival (OS) data. A multivariate Cox regression model was employed to identify prognostic factors influencing OS and PFS. A value of two-sided P&lt;0.05 was considered statistically significant.ResultsCompared to patients in the no POI group, patients in the POI group were more likely to have hepatic portal occlusion (78.9% vs. 66.3%, P=0.021), operation time ≥325 min (61.1% vs. 48.1%, P=0.026), and intraoperative blood loss ≥200 ml (81.1% vs. 67.6%, P=0.012). In multivariate analysis, intraoperative blood loss ≥200 ml (OR = 2.057, 95% CI: 1.165-3.634, P=0.013) was identified as the only independent risk factor for POI. Patients with POI had a worse PFS (P&lt;0.001, median PFS: 7.5 vs. 12.7 months) and a worse OS (P=0.010, median OS: 38.8 vs. 59.0 months) than those without POI. After 1:3 PSM analysis, no differences in clinicopathologic parameters were detected between the POI group and the no POI group. Patients with POI had a worse PFS (P=0.013, median PFS: 7.5 vs. 11.1 months) and a worse OS (P=0.020, median OS: 38.8 vs. 59.0 months) than those without POI. Multivariate analysis showed that POI was an independent predictor for worse PFS (HR=1.410, 95% CI: 1.065-1.869, P=0.017) and worse OS (HR=1.682, 95% CI: 1.113-2.544, P=0.014).ConclusionsPOI can significantly worsen the long-term outcomes of CRLM patients receiving simultaneous resection of colorectal cancer and liver metastases and should be considered to improve postoperative management and make better treatment decisions for these patients.

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