Totally Laparoscopic Strategies for the Management of Colorectal Cancer with Synchronous Liver Metastasis

Abstract
Background: The purpose of this study is to compare the laparoscopic techniques for the management of colorectal cancer with synchronous liver metastases:
Simultaneous laparoscopic liver and colon cancer resec-tion.
Simultaneous colon resection and Radiofrequency Ablation (RFA) of liver metastases.
Methods: Convenient sample of about 30 patients expected to attend the Oncology Center, Mansoura University (OCMU) Gastro-Enterology Center (GEC) during study period of 3 years (2014-2017) with adenocarcinoma of the colon and rectum with Synchronous Colorectal Liver Metastases (SCRLM) will be considered.
Results: Mean operative time was 205 minutes for LLR, in comparison with the resection group, mean operative time for RFA was 185 minutes. Though shorter in time, this did not appear to be statistically significant (p-value=4.41). Mean blood loss for the resection group was 350ml, and mean blood transfusion was 0.89L. On the other hand, mean blood loss for the RFA group was 90ml and mean blood transfusion was 0.76L. This difference between the two groups appeared to be statistically different (p-value=0.01). For the LLA group mean hospital stay 8.4 days and mean recovery time per case was 4.1 days. This was a bit shorter for the RFA group were mean hospital was 8.3 days while mean recovery time per case was 3.6 days. Although shorter, this difference appear to be insignificant statistically. (p-value=0.95/p-value=0.79 respectively).
Conclusions: Treatment of hepatic metastasis especially in colorectal hepatic lesion could prolong survival in selected cases, all the results of the systemic reviews and meta-analysis suggested an inferior outcome of non resectional treatment compared to hepatic resection.
Minimal invasive approach for treatment of CRLM offers more advantages such as early recovery, less pain, better cosmosis, less blood loss, and reduced morbidity and mortality with equal oncological outcome compared to classic open surgery.