I.E. Khatkov, Y.A. Barsukov, V.A. Aliev, D.V. Kuzmichev, A.O. Atroshchenko, R.I.Tamrazov, P.S. Tyutyunnik
Aim: to determine the role of cytoreductive laparoscopic surgery in combined treatment for patients with synchronous metastatic colorectal carcinoma.
Methods: the cytoreductive primary tumor removal, even in patients with synchronous multiple metastases allows to increase two-year survival up to 18.2% in comparison with symptomatic operations. Adjuvant chemotherapy after primary tumor removal may improve the two-year survival up to 52.7 %.The laparoscopic precision technique may minimize the surgical trauma and could help to optimize treatment strategy: to determine the treatment strategy and to expand the indications for cytoreductive operations, especially in patients burdened with co morbidity.
Since 2010 year was performed 23 laparoscopic operations in patients with synchronous metastases from colorectal carcinoma and different co morbidities at the age of 63-79. The depth of invasion of primary tumor T3 was registered in 15 and T4 – 5 patients. Metastases in one organ (M1a) were diagnosed in 13, two or more organs (M1b) - 7patients. Histological examination by the removal organs showed that the metastases to the regional lymph nodes were detected in 10 patients: N1 – 8 patients; N2 -2 patients. 13 patients underwent laparoscopic cytoreductive resection with primary tumor removal: right hemicolectomy – 3, left hemicolectomy – 2,sigmoid colectomy - 6, low rectal resection - 1, low anterior resection with sigma - anal anastomosis– 1 patient. In all cases the primary anastomosis had done. In one case atypical liver resection was performed simultaneously. In 3 patients diagnostic laparoscopy revealed a total carcinomatosis, it was the reason for conversion for laparotomy. 7 patients underwent the symptomatic operations by laparoscopic access: colostomy underwent - 6, bypass formed in 1patient. Stapled anastomoses "end to end" were formed in 9; hand – assisted "side to side” in 3 patients, sigma-anal anastomosis – 1patient. The anastomotic leakage was noted only in one patient – stapled anastomosis after low rectal resection without preventive colostomy. In one patient - the suppuration of minilaparotomy wound was admitted.
Conclusions: laparoscopic operations have the same efficacy in comparison with open surgery and may be included in combined treatment for patients with synchronous metastases of colorectal carcinoma.
Иван Недолужко, заведующий отделением оперативной эндоскопии, выступил экспертом с образовательным курсом и лекцией
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