Academic literature on the topic 'Rectal cancer, colorectal liver metastasis, minimally invasive surgery'

Rectal cancer is a distinct subset of colorectal cancer where specialized disease-specific management of the primary tumor is required. There have been significant developments in rectal cancer surgery at all stages of disease in particular the introduction of local excision strategies for preinvasive and early cancers, standardized total mesorectal excision for resectable cancers incorporating preoperative short- or long-course chemoradiation to the multimodality sequencing of treatment. Laparoscopic surgery is also increasingly being adopted as the standard rectal cancer surgery approach following expertise of colorectal surgeons in minimally invasive surgery gained from laparoscopic colon resections. In locally advanced and metastatic disease, combining chemoradiation with radical surgery may achieve total eradication of disease and disease control in the pelvis. Evidence for resection of metastases to the liver and lung have been extensively reported in the literature. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases is showing promise in achieving locoregional control of peritoneal dissemination. This paper summarizes the recent developments in approaches to rectal cancer surgery at all these time points of the disease natural history.

Summary: Introduction: The Czech Republic belongs to countries under significant strain due to malignant tumours. Despite the changes introduced in the therapy of gastrointestinal malignancies, radical removal of the tumour holds a crucial position in the mutimodal therapeutic process and is irreplaceable nowadays. From the beginning of the third millennium, minimally invasive surgery of abdominal tumours is being expanded with robotic-assisted procedures. The aim of this paper is to assess the benefits of robotic-assisted surgery in the treatment of colorectal and hepatopancreatobiliary neoplasms and to present the results of a non-randomized study with prospectively collected data from robotically assisted rectal cancer surgeries. Material and method: The authors summarize studies published in the PubMed, EMBASE, Medline and Cochrane Library databases that compare robotic and laparoscopic approaches in the treatment of colorectal and hepatopancreatobiliary malignancies, and present the results of their own non-randomized study. 204 patients with rectal cancer (<15 cm from the anal verge) who underwent robotic-assisted surgery at our department between 1 January 2016 and 31 December 2020 were included in the study. All demographic, clinical and oncological data were prospectively obtained and analysed. The data were analysed using descriptive statistic methods. Results: 204 patients with rectal cancer of whom 138 were men and 66 were women underwent robotic surgery at our department during the five-year period. In 97 (47.5%) cases the disease was dia­gnosed in an advanced stage (stage III and IV of the TNM classification). 18 patients had synchronous liver metastases and 2 patients had pulmonary metastases at the time of the dia­gnosis. The liver-first approach was indicated in 8 (44.4%) patients, two patients underwent a radical resection of liver lesions together with the primary neoplasm in one surgery. Total mesorectal excision was performed in 136 patients with extraperitoneal disease, partial mesorectal excision was performed in 68 cases. 18 complications were documented. Clinically relevant anastomotic leak requiring intervention occurred in 5 (3.6%) cases. One patient died due to decompensation of chronic toxonutritive liver disease. Local recurrence was documented in 6 patients, half of them underwent radical resection. Conclusion: Surgical therapy holds a crucial position in the treatment of colorectal and hepatopancreatobiliary neoplasms and represents the only potentially curative procedure in multimodal therapy. Robotic-assisted therapy has become a routine therapeutic modality for colorectal and hepatopancreatobiliary malignancies worldwide. Da Vinci assisted surgeries prevail in the surgical treatment of rectal cancer at the authors’ workplace as well as at some foreign centres. Compared to open and laparoscopic resections of rectal carcinoma, robotic-assisted operations achieve the same clinical and oncological results with a lower rate of complications. Key words: robotic surgery – colorectal cancer – liver malignancies – pancreatic carcinoma

485 Background: Colorectal cancer (CRC) is the third leading cause of cancer death. At the time of diagnosis 25% of patients present with stage IV disease and out of all CRC patients 50% develop liver metastases. About 15% of them have initially resectable disease. Surgical resection is the best treatment option as it is associated with longer survival. Latvia Oncology center (LOC) provide expertise in managment of all cancers, including metastatic CRC. Methods: Data about CRC patients with surgicaly treated liver metastases was colected and analysed from Latvia Oncology center in period 2011-2014. This data is also included in LiverMetSurvey international registry of patients operated for CRC liver metastases. 66 patients underwent hepatectomies, 10 patients had 2 or more surgeries due to a reccurent disease. Results: 77 surgeries were performed, 31 were hemihepatectomies and 46 were limited resections. Sinchronous surgery for liver metastases and primary tumor were performed in 19 cases: 11 for left colon cancer, 6 for rigt colon cancer and 2 for rectal cancer. Initially resectable liver disease was found in 70 cases. Unilateral metastases were diagnosed in 61 cases while there were 17 cases of bilateral disease. Postoperative complications developed in 18 patients, 5 of those after sinchronous surgeries for primary tumor. In 10 cases complications developed after major anatomical right sided hemihepatectomy and in 8 cases after atypical resections. Most frequent hepatic complications were infected collection in hepatic loge (n=9), non infected collection (n=3) and biliary leak (n=3); all of those were successfully treated with percutaneous dreinage. 1 patient died due to a postoperative liver insufficiency after right sided hemihepatectomy for recurrent disease. Conclusions: Overall 77 hepatectomies were performed, mostly limited non anatomical resections. In majority of patients 1 or 2 metastases were diagnosed. Initally resectable were 89% of cases. Mass of postoperative complications developed after major hepatectomies, were liver related and successfully treated with minimally invasive procedures. Complication rate (16%) in LOC is comperable to other Europian centers.

Purpose. To analyse perioperative and oncological outcomes of minimally invasive simultaneous resection of primary colorectal neoplasm with synchronous liver metastases.Methods. A Medline revision of the current published literature on laparoscopic and robotic-assisted combined colectomy with hepatectomy for synchronous liver metastatic colorectal neoplasm was performed until February 2015. The specific search terms were “liver metastases”, “hepatic metastases”, “colorectal”, “colon”, “rectal”, “minimally invasive”, “laparoscopy”, “robotic-assisted”, “robotic colorectal and liver resection”, “synchronous”, and “simultaneous”.Results. 20 clinical reports including 150 patients who underwent minimally invasive one-stage procedure were retrospectively analysed. No randomized trials were found. The approach was laparoscopic in 139 patients (92.7%) and robotic in 11 cases (7.3%). The rectum was the most resected site of primary neoplasm (52.7%) and combined liver procedure was in 89% of cases a minor liver resection. One patient (0.7%) required conversion to open surgery. The overall morbidity and mortality rate were 18% and 1.3%, respectively. The most common complication was colorectal anastomotic leakage. Data concerning oncologic outcomes were too heterogeneous in order to gather definitive results.Conclusion. Although no prospective randomized trials are available, one-stage minimally invasive approach seems to show advantages over conventional surgery in terms of postoperative short-term course. On the contrary, more studies are required to define the oncologic values of the minimally invasive combined treatment.

The liver is the most common site of colorectal cancer metastasis. Liver surgery is a cornerstone in treatment, with progressive expansion of minimally invasive surgery (MIS). This study aims to compare short- and long-term outcomes of open surgery and MIS for the treatment of colorectal adenocarcinoma liver metastasis during the first three years of increasing caseload and implementation of MIS use in liver surgery. All patients treated between November 2018 and August 2021 at Careggi Teaching Hospital in Florence, Italy, were prospectively entered into a database and retrospectively reviewed. Fifty-one patients were resected (41 open, 10 MIS). Considering that patients with a significantly higher number of lesions underwent open surgery and operative results were similar, postoperative morbidity rate and length of hospital stay were significantly higher in the open group. No differences were found in the pathological specimen. The postoperative mortality rate was 2%. Mean overall survival and disease-free survival were 46 months (95% CI 42–50) and 22 months (95% CI 15.6–29), respectively. The use of minimally invasive techniques in liver surgery is safe and feasible if surgeons have adequate expertise. MIS and parenchymal sparing resections should be preferred whenever technically feasible.

Minimally invasive surgical techniques for liver tumors are gaining increased acceptance as an alternative to traditional resections by laparotomy. In this article we describe a laparoscopic liver resection of a metastatic lesion in a patient primarily operated for colorectal cancer. The resection was conducted as a single port procedure through the stoma aperture at time of reversal of the diversion ileostomy. Sigle incision liver resections may be less traumatic than conventional laparoscopy and could be applied in selected patients with both benign and malignant liver tumors.

Background. Surgical treatment is the cornerstone in the management of colorectal cancer (CRC) liver metastases. The aim of this study is to identify clinicopathological factors affecting disease-free (DFS) and overall survival (OS) in patients undergoing potentially curative liver resection for CRC metastasis. Methods. All consecutive patients undergoing liver resection for first recurrence of CRC from February 2006 to February 2018 were included. Prognostic impact of factors related to the patient, primary and metastatic tumors, was retrospectively tested through univariate and multivariate analyses. Results. Seventy patients were included in the study. Median postoperative follow-up was 37 months (range 1–119). Median DFS and OS were 15.2 and 62.7 months, and 5-year DFS and OS rates were 16% and 53%. In univariate analysis, timing of metastasis presentation/treatment (combined colorectal and liver resection, “bowel first” approach or metachronous presentation) (p<0.0001), ASA score (p=0.003), chemotherapy after liver surgery (p=0.028), T stage (p=0.021), number of resected liver lesions (p<0.0001), and liver margin status (p=0.032) was significantly associated with DFS while peritoneal resection at colorectal surgery (p=0.026), ASA score (p=0.036), extension of liver resection (p=0.024), chemotherapy after liver surgery (p=0.047), and positive nodes (p=0.018) with OS. In multivariate analysis, timing of metastasis presentation/treatment, ASA score, and chemotherapy (before and after liver surgery) resulted significantly associated with DFS and timing of metastasis presentation/treatment, positive nodes, peritoneal resection at colorectal surgery, and surgical approach (open or minimally invasive) of colorectal resection with OS. Conclusions. Surgery may provide good DFS and OS rates for CRC liver metastasis. Patient selection for surgery and correct timing of intervention within a multidisciplinary approach may be improved by taking into account negative prognostic factors which stress the importance of systemic therapy.

Introduction. Colorectal cancer (CRC) is a common tumour and a leading cause of death. Up to 70% of the patients present with or will develop distant metastasis being the liver the most common site of disease recurrence. Surgery is one of the mainstays within the multimodal treatment of CRC. In rectal surgery, the total mesorectal excision (TME) is a crucial step while in liver surgery, accurate planning of the resection is required to allow the complete tumour removal preserving an adequate liver remnant. Minimally invasive surgery (MIS) is still far from being considered a gold standard but its use is in progressive expansion in both colorectal and liver surgery owing to the better short-term outcomes and the at least non-inferiority of MIS over open surgery. However, within the minimally invasive techniques, no clear benefits of the robotic platform have been demonstrated yet. The aims of this study are to compare laparoscopic and robotic surgery for lower rectum cancer and to compare open and MIS for the treatment of the first occurrence of liver metastasis from colorectal adenocarcinoma in terms of short and long-term outcomes. Material and Methods. During the study period, from November 2018 to August 2021, all the patients undergoing anterior resection of the rectum with a colorectal anastomosis for lower rectum cancer and all the patients undergoing liver rection for the first occurrence of metastasis from colorectal adenocarcinoma were prospectively entered into a dedicated database. Demographic aspects, tumour characteristics, perioperative data, pathological results, and long-term outcomes were evaluated and retrospectively analysed. Results. Fifteen patients underwent anterior resection of the rectum, 8 were treated with laparoscopy and 7 with the robotic technique. No differences were found in the preoperative data. However, the great majority of the patients receiving neoadjuvant therapies were treated with the robotic technique. A significantly longer surgery time was associated with the robotic technique while postoperative course and morbidity rates were similar. The specimens from the patients treated with the robotic technique presented with significantly smaller tumours, lower T stage, lower number of nodes harvested (but with a mean above the required number of 12), wider CMR, and similar quality of mesorectum excision. All the patients are actually alive but 3 of them experienced disease recurrence. No differences in DFS were found (p=0.165). Fifty-one patients underwent liver resection, 41 were treated with open surgery and 10 with MIS. One patient in the open group died within 15 days after surgery (postoperative mortality rate of 2%) and she was excluded from the analysis. No significant differences were found in patient characteristics while patients with a significantly higher number of lesions were treated with the open technique. Operative results were similar except for the Pringle maneuver which was more frequently used in open surgery. Postoperative morbidity rate and length of hospital stay were significantly higher in the open group. No differences were found in the pathological specimen, in particular in the resection margin and KRAS status. The estimated mean OS was 46 months (95% CI 42-50). All the dead patients were treated with an open technique, thus precluding further comparative analysis. Sixty percent of the patients experienced recurrence. The estimated mean and median DFS was 22 months (95% CI 15,6-29) and 8 months. No differences were found for the techniques in DFS (p=0.164) even stratifying the analysis for several factors including the number of lesions, the technique used to treat primary cancer (p=0.148), and margin status (p=0.153), KRAS mutation (p=0.735). Conclusions. For difficult cases of rectal surgery, including patients with higher BMI and those who received neoadjuvant treatment, the robotic technique may allow at least similar or better oncological results compared to laparoscopy. For liver surgery, MIS and parenchymal sparing resections should be preferred whenever technically feasible providing better short-term outcomes and similar oncologic results compared to open surgery and more extended resections. The expertise and the multidisciplinary evaluation are of paramount importance to provide the patients with the best treatment.