SIMULTANEOUS EXTENSIVE LIVER RESECTION IN PATIENTS WITH COLORECTAL CANCER

Objective. The choice of surgical tactics in patients with synchronous colorectal cancer metastases in the liver requiring extensive resection is rather difficult. This study was held to evaluate the immediate results of simultaneous operations with extensive liver resections compared to staged surgical interventions. Material and methods. From January 2013 to March 2016 40 patients with synchronous colorectal cancer metastases in the liver underwent extensive resection of the liver: 20 simultaneous operations (group 1) and 20 staged surgical interventions (group 2). Central liver resection (2/10%) and extended hemihepatectomy (5/25%) were performed only in the staged operations group (p = 0.062). For primary tumors in both groups resections of the rectum were mainly done: 15 (75%) and 12 (60%), respectively. Results. The results of group 2 are given in total after the first and second operations. Mortality in groups 1 and 2 was 0 and 1 (5%), respectively (p = 1.0). The frequency of complications amounted to 10 (50%) in both groups (p = 1.0). Hepatic failure was observed only in the group of staged operations for patients with extended hemihepatectomy: 3 (15%), p = 0.2. Biliary fistula was observed in 3 (15%) patients of group 1, and in 2 (10%) patients of group 2, p = 1.0. The median blood loss was less in the group of simultaneous operations than in group of staged operations (375 vs. 850 ml, p = 0.035). Postoperative hospital stay in the group of simultaneous liver resections compared with the second stage of surgical treatment in group 2 was similar and amounted to 19 (15;28), and 19 (14;21), respectively (p = 0.4). Conclusion. Simultaneous operations consisting of standard resection of the large intestine and removal of up to 70% of the liver parenchyma do not increase the frequency, the structure of complications and mortality in comparison with the staged interventions, as well as do not increase the periods of postoperative recovery.

Kelly M.E., Spolverato G., Lê G.N., Mavros M.N., Doyle F., Pawlik T.M., Winter D.C. Synchronous colorectal liver metastasis: a network meta-analysis review comparing classical, combined, and liver-first surgical strategies. J. Surg. Oncol. 2015; 111 (3): 341-51. DOI: 10.1002/jso.23819

Veereman G., Robays J., Vèrleye L., Leroy R., Rolfo C., Van Cutsem E. et al. Pooled analysis of the surgical treatment for colorectal cancer liver metastases. Crit. Rev. Oncol. Hematol. 2015; 94 (1): 122-35. DOI: 10.1016/j.critrevonc.2014.12.004

Schmoll H.J., Van Cutsem E., Stein A., Valentini V., Glimelius B., Haustermans K. et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann. Oncol. 2012; 23 (10): 2479-516. DOI: 10.1093/annonc/mds236

National Comprehensive Cancer Network. Rectal Cancer (Vèrsion 3.2017) 2017 [updated March 13, 2017]. Available at: https:// www.nccn.org/professionals/physician_gls/pdf/rectal_blocks.pdf (accessed November 28, 2017).

National Comprehensive Cancer Network. Colon Cancer (Version 2.2017) 2017 [updated March 13, 2017]. Available at: https:// www.nccn.org/professionals/physician_gls/pdf/colon_blocks.pdf (accessed November 28, 2017).

Fukami Y., Kaneoka Y., Maeda A., Takayama Y., Onoe S., Isogai M. Simultaneous resection for colorectal cancer and synchronous liver metastases. Surg. Today. 2016; 46 (2): 176-82. DOI: 10.1007/s00595-015-1188-1

Li Y., Bi X., Zhao J., Huang Z., Zhou J., Li Z. et al. Simultaneous hepatic resection benefits patients with synchronous colorectal cancer liver metastases. Chin. J. Cancer Res. 2016; 28 (5): 528-35. DOI: 10.21147/j.issn.1000-9604.2016.05.08

Silberhumer G.R., Paty P.B., Denton B., Guillem J., Gonen M., Araujo R.L. et al. Long-term oncologic outcomes for simultaneous resection of synchronous metastatic liver and primary colorectal cancer. Surgery. 2016; 160 (1): 67-73. DOI: 10.1016/ j.surg.2016.02.029

Van der Pool A.E., de Wilt J.H., Lalmahomed Z.S., Eggermont A.M., Ijzermans J.N., Verhoef C. Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases. Br. J. Surg. 2010; 97 (3): 383-90. DOI: 10.1002/bjs.6947

Chua H.K., Sondenaa K., Tsiotos G.G., Larson D.R., Wolff B.G., Nagorney D.M. Concurrent vs. staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases. Dis. Colon Rectum. 2004; 47 (8): 1310-6.

Moug S.J., Smith D., Leen E., Roxburgh C., Horgan P.G. Evidence for a synchronous operative approach in the treatment of colorectal cancer with hepatic metastases: a case matched study. EJSO. 2010; 36 (4): 365-70. DOI: 10.1016/j.ejso.2009.11.007

Патютко Ю.И., Чучуев Е.С., Подлужный Д.В., Поляков А.Н., Агафонова М.Г. Хирургическая тактика в лечении колоректального рака с синхронными метастазами в печень. Онкологическая колопроктология. 2011; 2: 13-20. [Patyutko Y.I., Chuchuyev E.S., Podluzhny D.V., Polyakov A.N., Agafonova M.G. Surgical tactics for colorectal cancer with synchronous liver metastases. Onkologicheskaya Koloproktologiya (Colorectal Oncology). 2011; 2: 13-20 (in Russ.).]

Mayo S.C., Pulitano C., Marques H., Lamelas J., Wolfgang C.L., de Saussure W. et al. Surgical management of patients with synchronous colorectal liver metastasis: a multicenter international analysis. J. Am. Coll. Surg. 2013; 216 (4): 707-16, discussion 716-8. DOI: 10.1016/j.jamcollsurg.2012.12.029

Ejaz A., Semenov E., Spolverato G., Kim Y., Tanner D., Hundt J., Pawlik T.M. Synchronous primary colorectal and liver metastasis: impact of operative approach on clinical outcomes and hospital charges. HPB (Oxford). 2014; 16 (12): 1117-26. DOI: 10.1111/hpb.12302

Castellanos J.A., Merchant N.B. Strategies for management of synchronous colorectal metastases. Curr. Surg. Rep. 2014; 2: 62. DOI: 10.1007/s40137-014-0062-1

Capussotti L., Ferrero A., Vigano L., Ribero D., Lo Tesoriere R., Polastri R. Major liver resections synchronous with colorectal surgery. Ann. Surg. Oncol. 2007; 14 (1): 195-201. DOI: 10.1245/ s10434-006-9055-3

Weber J.C., Bachellier P., Oussoultzoglou E., Jaeck D. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br. J. Surg. 2003; 90 (8): 956-62. DOI: 10.1002/bjs.4132

Abbott D.E., Cantor S.B., Hu C.Y., Aloia T.A., You Y.N., Nguyen S., Chang G.J. Optimizing clinical and economic outcomes of surgical therapy for patients with colorectal cancer and synchronous liver metastases. J. Am. Coll. Surg. 2012; 215 (2): 262-70. DOI: 10.1016/j.jamcollsurg.2012.03.021

Slesser A.A., Chand M., Goldin R., Brown G., Tekkis P P, Mudan S. Outcomes of simultaneous resections for patients with synchronous colorectal liver metastases. Eur. J. Surg. Oncol. 2013; 39 (12): 1384-93. DOI: 10.1016/j.ejso.2013.09.012

SheW.H., Chan A.C., Poon R.T., Cheung T.T., Chok K.S., Chan S.C., Lo C.M. Defining an optimal surgical strategy for synchronous colorectal liver metastases: staged versus simultaneous resection? ANZJ. Surg. 2015; 85 (11): 829-33. DOI: 10.1111/ans.12739

Березовская Т.П., Невольских А.А., Бердов Б.А., Кондрашова Л.М., Горбань Н.А. Возможности МРТ в диагностике метастатического поражения регионарных лимфатических узлов при раке прямой кишки. Колопроктология. 2013; 45 (3): 3-9. [Berezovskaja T.P., Nevol'skih A.A., Berdov B.A., Kondrashova L.M., Gorban' N.A. MRI is a diagnostic tool for rectal carcinoma nodal metastases. Koloproktologia (Coloproctology). 2013; 45 (3): 3-9 (in Russ.).]

Шелыгин Ю.А., Ачкасов С.И., Рыбаков Е.Г., Майнов-ская О.А., Сушков О.И., Запольский А.Г. Железисто-плоскоклеточный рак поперечной ободочной кишки (клиническое наблюдение и обзор литературы). Колопроктология. 2014; 50 (4): 56-59. [Sheligin Yu.A., Achkasov S.I., Rybakov E.G., Maynovskaya O.A., Sushkov O.I., Zapolskiy A.G. Adenosquamous carcinoma of transversum (case report and literature review). Koloproktologia (Coloproctology). 2014; 50 (4): 56-59 (in Russ.).]

Nordlinger B., Guiguet M., Vaillant J.C., Balladur P., Boudjema K., Bachellier P., Jaeck D. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Française de Chirurgie. Cancer. 1996; 77 (7): 1254-62.

Bolton J.S., Fuhrman G.M. Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann. Surg. 2000; 231 (5): 743-51.

Slesser A.A., Simillis C., Goldin R., Brown G., Mudan S., Tekkis PP A meta-analysis comparing simultaneous versus delayed resections in patients with synchronous colorectal liver metastases. Surg. Oncol. 2013; 22 (1): 36-47. DOI: 10.1016/j.suronc. 2012.11.002

Feng Q., Wei Y., Zhu D., Ye L., Lin Q., Li W et al. Timing of hepa-tectomy for resectable synchronous colorectal liver metastases: for whom simultaneous resection is more suitable - a meta-analysis. PloS ONE. 2014; 9 (8): e104348. DOI: 10.1371/journal. pone.0104348

Yin Z., Liu C., Chen Y., Bai Y., Shang C., Yin R. et al. Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): simultaneous or delayed? Hepatology. 2013; 57 (6): 2346-57. DOI: 10.1002/hep.26283

Chen J., Li Q., Wang C., Zhu H., Shi Y., Zhao G. Simultaneous vs. staged resection for synchronous colorectal liver metastases: a metaanalysis. Int. J. Colorectal Dis. 2011; 26 (2): 191-9. DOI: 10.1007/s00384-010-1018-2

Reddy S.K., Pawlik T.M., Zorzi D., Gleisner A.L., Ribero D., Assumpcao L. et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann. Surg. Oncol. 2007; 14 (12): 3481-91. DOI: 10.1245/s10434-007-9522-5

Figueras J., Llado L., Ruiz D., Ramos E., Busquets J., Rafecas A. et al. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial. Ann. Surg. 2005; 241 (4): 582-90. DOI: 10.1097/01.sla.0000157168.26021.b8

Elias D., Detroz B., Lasser P., Plaud B., Jerbi G. Is simultaneous hepatectomy and intestinal anastomosis safe? Am. J. Surg. 1995; 169 (2): 254-60. DOI: 10.1016/S0002-9610(99)80146-9

Martin R., Paty P., Fong Y., Grace A., Cohen A., DeMatteo R. et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J. Am. Coll. Surg. 2003; 197 (2): 233-41, discussion 241-2. DOI: 10.1016/S1072-7515(03)00390-9

De Haas R.J., Adam R., Wicherts D.A., Azoulay D., Bismuth H., Vibert E. et al. Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases. Br. J. Surg. 2010; 97 (8): 1279-89. DOI: 10.1002/bjs.7106

Luo Y., Wang L., Chen C., Chen D., Huang M., Huang Y. et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastases. J. Gastrointest. Surg. 2010; 14 (12): 1974-80. DOI: 10.1007/s11605-010-1284-x

Peeters K.C., Tollenaar R.A., Marijnen C.A., Klein Kranenbarg E., Steup W.H., Wiggers T. et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br. J. Surg. 2005; 92 (2): 211-6. DOI: 10.1002/bjs.4806