Total Laparoscopic Management for Stage IV Colorectal Cancer Requiring Multivisceral Resection

Total Laparoscopic Management for Stage IV Colorectal Cancer Requiring Multivisceral Resection Ann Surg Oncol (2017) 24:2595 DOI 10.1245/s10434-017-5878-3 OR IGINAL ARTIC L E – COLORECTAL CANCER Total Laparoscopic Management for Stage IV Colorectal Cancer Requiring Multivisceral Resection 1 1 1 1 Y. Nancy You, MD, MHSc , Hironori Shiozaki, MD , Jeffrey E. Lee, MD , Guillaume Passot, MD, MSc , 1 1 1 1 Claire Goumard, MD , Masayuki Okuno, MD, PhD , Thomas A. Aloia, MD , Cathy Eng, MD , George Chang, MD, 1 1 1,2 MS , Jean-Nicolas Vauthey, MD , and Claudius Conrad, MD, PhD 1 2 Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, Houston, TX ABSTRACT surgery and the second-stage liver resection. Postoperative Background. Surgical resection of all sites of disease, in lengths of stay were 4 and 3 days, respectively, and were combination with effective systemic chemotherapy, offers without complication. Adjuvant FOLFOX was initiated the only potential chance for cure for patients with stage IV 21 days following liver surgery, and the patient has been colorectal cancer (CRC). Coordinated multistage resection disease-free for 36 months. using a minimally invasive approach may provide optimal Conclusion. This case illustrates the feasibility of the total oncologic outcome while potentially offering the benefit of laparoscopic approach to multivisceral resection for syn- decreased morbidity. chronous stage IV CRC in the context of a preplanned, Patient. A 66-year-old women presented with transverse staged multidisciplinary strategy. This approach may offer colon cancer and synchronous metastasis (CRLM) in seg- optimal cancer management, including early return to ment IV involving the middle hepatic vein and main left systemic therapy, shortened time intervals between stages, 1–3 portal pedicle, as well as the left adrenal gland. Due to and minimal postoperative morbidity. favorable response to neoadjuvant chemotherapy (FOL- FOX/bevacizumab), the patient was considered for DISCLOSURE Y. Nancy You, Hironori Shiozaki, Jeffrey E. Lee, resection but developed some obstructive symptoms from Guillaume Passot, Claire Goumard, Masayuki Okuno, Thomas A. the primary tumor, necessitating re-coordination of treat- Aloia, Cathy Eng, George Chang, Jean-Nicolas Vauthey, and Clau- ment sequencing from the ‘liver-first’ approach. dius Conrad have declared no conflicts of interest. Methods. The first procedure combined laparoscopic subtotal colectomy (extracorporeal anastomosis) with left adrenalectomy. After restaging, CRLM was removed sep- REFERENCES arately 2 months later via laparoscopic left hepatectomy 1. Conrad C, Gayet B (eds). Laparoscopic liver, pancreas, and biliary extending beyond the middle hepatic vein. Successful surgery: textbook and illustrated video atlas. Wiley-Blackwell, completion of the two procedures depended on optimal Chichester; 2017. patient/port positioning for the combined colon/adrenal 2. Yamashita S, Sheth RA, Niekamp AS, Aloia TA, Chun YS, Lee JE, et al. Comprehensive complication index predicts cancer- specific survival after resection of colorectal metastases indepen- dent of RAS mutational status. Ann Surg. Epub 4 Oct 2016. 3. Mise Y, Aloia TA, Brudvik KW, Schwarz L, Vauthey JN, Conrad C. Electronic supplementary material The online version of this Parenchymal-sparing hepatectomy in colorectal liver metastasis article (doi:10.1245/s10434-017-5878-3) contains supplementary improves salvageability and survival. Ann Surg. 2016;263(1):146–52. material, which is available to authorized users. Society of Surgical Oncology 2017 First Received: 21 February 2017; Published Online: 16 May 2017 C. Conrad, MD, PhD e-mail: Annals of Surgical Oncology Springer Journals

Total Laparoscopic Management for Stage IV Colorectal Cancer Requiring Multivisceral Resection

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Springer International Publishing
Copyright © 2017 by Society of Surgical Oncology
Medicine & Public Health; Surgical Oncology; Oncology; Surgery
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