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Outcomes of laparoscopic primary tumor removal for disseminated colon cancer.

Authors: I.E. Khatkov, Y.A. Barsukov, V.A. Aliev, D.V. Kuzmichev, A.O. Atroshchenko,S.V. Pozdnyakov, P.S. Tyutyunnik.

Background: the primary tumor resection, even in patients with synchronous multiple metastases in the liver and/or other organs, allows to increase two-year survival in comparison with symptomatic operations (colostomy or bypass). Adjuvant chemotherapy after cytoreductive surgery may improve the results of a two-year survival. The laparoscopic precision technique may minimize the surgical complications and to shorten the time to chemotherapy. It could helps to optimize treatment strategy and to expand the indications for cytoreductive operations, especially for elderly patient

The aim of the study is to determine the role of laparoscopic cytoreductive surgery in combined treatment for patients with colon cancer and synchronous distance metastases.

Materials and methods: 44 patients (30-80 years old) underwent laparoscopic primary tumor removal: T2-2 and T3-42 patients, metastases in one organ (M1a) were diagnosed in 37, two or more organs (M1b)-7 patients. Right hemicolectomy underwent 9 patients, left hemicolectomy-3, sigmoidectomy-24, rectal resection-3, and Hartman’s procedure-5. The preoperative complications of the primary tumor were detected in 31patients (bleeding-12, obstipation-14, toxicemia-7). Simultaneous R0 resection performed in 2 patients, staged resection-10.

Results. The postoperative complications were diagnosed in 2(4,55%) patients (1-anastomosis leakage, 1- mesenteric ischemia) that is 2 times less as compared to open surgery. The average hospital stay in the clinic was 7 days. The time to start the chemotherapy reduced since 30 days after open surgery up to 14 days after laparoscopic procedure. The 2-year survival results after open and laparoscopic surgery were comparable: 69,5% after laparoscopic and 61,5%-after open surgery, p=0,97.

Conclusions: the laparoscopic surgery can be included in combined treatment scheme for disseminated colon cancer especially for elderly patients.

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