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Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases

World Journal of Gastrointestinal Oncology 2018年第10期10卷 293-316页

作者： Emilio De Raffele Mariateresa Mirarchi Dajana Cuicchi Ferdinando Lecce Claudio Ricci Riccardo Casadei Bruno Cola Francesco Minni Unità Operativa di Chirurgia Generale Dipartimento dell’Apparato DigerenteAzienda Ospedaliero-Universitaria di BolognaPoliclinico S.Orsola-Malpighi U.O.di Chirurgia Generale Dipartimento Strutturale Chirurgico Ospedale "Antonio e Margherita" Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) Alma Mater Studiorum Policlinico S.Orsola-Malpighi University of Bologna

Synchronous colorectal carcinoma(SCRC) indicates more than one primary colorectal carcinoma(CRC) discovered at the time of initial presentation, accounts for 3.1%-3.9% of CRC, and may occur either in the same or in different colorectal segments. The accurate preoperative diagnosis of SCRC is difficult and diagnostic failures may lead to inappropriate treatment and poorer prognosis. SCRC requires colorectal resections tailored to individual patients, based on the number, location, and stage of the tumours, from conventional or extended hemicolectomies to total colectomy or proctocolectomy, when established predisposing conditions exist. The overall perioperative risks of surgery for SCRC seem to be higher than for solitary CRC. Simultaneous colorectal and liver resection represents an appealing surgical strategy in selected patients with CRC and synchronous liver metastases(CRLM), even though the cumulative risks of the two procedures need to be adequately evaluated. Simultaneous resections have the noticeable advantage of avoiding a second laparotomy, give the opportunity of an earlier initiation of adjuvant therapy, and may significantly reduce the hospital costs. Because an increasing number of recent studies have shown goodresults, with morbidity, perioperative hospitalization, and mortality rates comparable to staged resections, simultaneous procedures can be selectively proposed even in case of complex colorectal resections, including those for SCRC and rectal cancer. However, in patients with multiple bilobar CRLM, major hepatectomies performed simultaneously with colorectal resection have been associated with significant perioperative risks. Conservative or parenchymal-sparing hepatectomies reduce the extent of hepatectomy while preserving oncological radicality, and may represent the best option for selected patients with multiple CRLM involving both liver lobes. Parenchymal-sparing liver resection, instead of major or two-stage hepatectomy for bilobar disea

关键词： Colorectal surgery Synchronous colorectal liver metastases Major hepatectomy parenchymalsparing hepatectomy Intraoperative ultrasonography Simultaneous colorectal and liver surgery Synchronous colorectal carcinoma Ablative therapies

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Parenchymal-sparing liver surgery in patients with colorectal carcinoma liver metastases

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World Journal of Gastrointestinal Surgery 2016年第6期8卷 407-423页

作者： Fernando A Alvarez Rodrigo Sanchez Claria Sebastian Oggero Eduardo de Santibanes General Surgery Service Hospital Italiano de Buenos Aires Buenos Aires C1181ACH Argentina

Liver resection is the treatment of choice for patients with colorectal liver metastases(CLM).However,major resections are often required to achieve R0 resection,which are associated with substantial rates of morbidity and *** the amount of residual liver gained increasing significance in modern liver surgery due to the high incidence of chemotherapyassociated parenchymal *** fact,along with the progressive expansion of resectability criteria,has led to the development of a surgical philosophy known as "parenchymal-sparing liver surgery"(PSLS).This philosophy includes a variety of resection strategies,either performed alone or in combination with ablative therapies.A profound knowledge of liver anatomy and expert intraoperative ultrasound skills are required to perform PSLS appropriately and *** is a clear trend toward PSLS in hepatobiliary centers worldwide as current evidence indicates that tumor biology is the most important predictor of intrahepatic recurrence and survival,rather than the extent of a negative resection *** removal avoiding the unnecessary sacrifice of functional parenchyma has been associated with less surgical stress,fewer postoperative complications,uncompromised cancer-related outcomes and higher feasibility of future *** increasing evidence supporting PSLS prompts its consideration as the gold-standard surgical approach for CLM.

关键词： Colorectal liver metastases parenchymalsparing hepatectomy Ultrasound Liver failure Resection margins Complications Ablative therapies

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