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Laparoscopic cytoreductive operations for patients with colorectal carcinoma with synchronous distant metastases.

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

The aim of the study is to determine the role of cytoreductive laparoscopic surgery in combined treatment for patients with colorectal carcinoma with synchronous distant metastases.

Methods. Between January 2010 and December 2010 20 patients underwent laparoscopic surgery at the department of proctology of N.N.Blokhin Cancer Research Center. Fifteen (75%) patients had T3 tumors and 5(25%) - T4. Metastases in one organ (M1a) were diagnosed in 13(65%) patients, two or more organs (M1b) - 7(35%) patients. Pathological examination revealed regional lymph nodes metastases in 10(50%) patients: N1 – 8; N2 – in 2 patients.

Results. The volume of laparoscopic operations was: right hemicolectomy - 3(15%), left hemicolectomy - 2(10%), sigmoid colectomy - 6(30%), low anterior resection - 1(5%), low anterior resection with coloanal anastomosis (LAR-CAA) – 1(5%). Six (30%) patients underwent only colostomy and 1 (5%) – bypass surgery. One patient had simultaneous atypical liver resection. Primary anastomosis was performed in 13(65%) patients: stapled anastomoses "end to end" - 9(45%); hand - assisted anastomoses "side to side” - 3(15%), coloanal anastomosis – 1(5%). Diagnostic laparoscopy revealed peritoneal carcinomatosis in 3 patients. One of them had conversion and open bypass surgery, 2 had laparoscopic colostomy. Totally laparoscopic access was performed in 17(85%) patients, video-assisted – in 3(15%). Only one (5%) patient had anastomotic leakage after stapled anastomosis for low anterior resection. One patient (5%) had suppuration of minilaparotomy wound. The average hospital stay in the clinic was 10.3 days.

Conclusions. Laparoscopic surgery has similar results to open technique and may be included in combined treatment program for patients with synchronous metastases of colorectal carcinoma.

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