The Laparoscopic Treatment Of The Colorectal Cancer With Unresectable Synchronous Liver Metastases

Background:In21st century, with the developing of laparoscopic minimally invasive technique and the gradual accumulation of surgical experience, the laparoscopic technique is developing rapidly in the surgical field and is accepted by more and more patients and doctors. The laparoscopic surgery of colorectal cancer has gradually developed into a mature surgical approach. Because of the primary tumor and liver metastases existing at the same time, it requires a comprehensive assessment of the condition and take the appropriate methods for the treatment of synchronous colorectal liver metastases. Especially in the unresectable liver metastases, the clinical strategies need to fully assess the condition and adopt combined treatment. The aim of this study is to investigate the feasibility and clinical value of laparoscopic treatment of the colorectal cancer with the unresectable synchronous liver metastases.Methods:Between June2011and December2012, we have retrospectively analyzed the clinical data and follow-up results of31patients with unresectable synchronous colorectal liver metastases in our department. According to the different resective methods of primary tumor, it was divided into two groups. Group A:Open surgery group (n=18) which chosing traditional surgical resection of the primary colorectal tumor; Group B:Laparoscopic group (n=13) which chosing the laparoscopic resection of the primary tumor. All of patients took postoperative mFOLFOX6chemotherapy. We compared the mean operative time, blood loss, postoperative exhaust time, postoperative hospital stay, postoperative chemotherapy day and therapeutic effect between two groups.Results:Colorectal cancer resections were performed successfully on31patients and the conversion to open surgery was not occurred in laparoscopic group. And there were no severe complications in both two groups. All of patients accepted postoperative mFOLFOX6chemotherapy with at least2cycles. Group A:10males and8females; Group B:6males and7females. Age was from43to72years and the mean age was55.25±8.38years. Between Group A and Group B, the mean operative time was176.11±19.44min vs.188.46±18.18min,mean operative blood loss was83.88±20.04ml vs.59.23±10.38ml,mean postoperative exhaust time was85.83±5.86h vs.80.31±5.33h, mean postoperative hospital stay was13.94±2.71days vs.11.69±3.01days and postoperative chemotherapy day was30.50±3.72days vs.26.61±4.99days,respectively. In the effect of treatment, Group A:5patients with partial responses(PR),10patients with stable diseases(SD),3patients with progressive diseases(PD); Group B:4patients with partial responses(PR),8patients with stable diseases(SD),1patients with progressive diseases(PD). With the statistical analysis of two sets of data, there was no significant difference in operative time (P>0.05). However, in the laparoscopic group, the amount of blood loss was significantly lower (P<0.01), the postoperative exhaust time was significantly shorter, the post hospital stay was significantly reduced (P<0.05) and the time of postoperative chemotherapy was significantly in advance (P<0.05). Comparing the therapeutic effect, there was no significant difference between these two groups (P>0.05).Conclusions:Laparoscopic resection of primary tumor is safe and feasible for colorectal cancer with the unresectable synchronous liver metastases. Compared to open surgery, laparoscopic surgery for colorectal cancer with unresectable synchronous liver metastases has the advantages of less blood loss, smaller trauma, faster recovery of postoperative bowel function, significantly shorter hospital stay time and promoting earlier postoperative chemotherapy in the surgical resection of primary tumor. There is no significant difference in the therapeutic effect of the primary tumor and metastases between two groups and the laparoscopic surgery has nice clinical value.