MINIMALLY INVASIVE ONE-TIME TRIPLE-APPROACH FOR THE TREATMENT OF STAGE IV COLONIC CANCER
EAES Online Library. Poves Prim I. Jan 10, 2012; 20020
Dr. Ignasi Poves Prim
Dr. Ignasi Poves Prim
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Abstract
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Introduction: Laparoscopic approach for the treatment of colonic cancer (CC) is well established and widely accepted. On the contrary, for hepatic resections due to colo-rectal liver metastasis (CRLM) is still on debate. Radiofrequency ablation (RFA) is considered a second line treatment for CRLM and especially useful in cases of multiple bilobar metastasis and/or for combining with resective procedures. Simultaneous hepatic and colonic resection for treatment of colonic cancer with synchronous CRLM has been proved to be safe in selected cases requiring minor hepatic resections (two or less segments). Video presentation: In a screening study (positive fecal occult blood test) a 62 years-old man was diagnosed of a CC located 45 cm from the anus. On the staging study were detected two nodules suggestive of CRLM: one of 30 mm on segment II and one of 8 mm on segments VIII. It was decided to perform a triple approach (three procedures) in one time operation: percutaneous RFA and simultaneous laparoscopic left lateral segmentectomy and sigmoidectomy. First, an expert radiologist in interventional procedures performed a percutaneous RFA of the nodule in the segment VIII. It was used a Cool-Tip device (Covidien) during 10 minutes for achieving a 30 mm of diameter area ablation. The second procedure was to perform a conventional left lateral segmentectomy without hiliar clamping. The parenchymotomy was done using Ligasure V (Covidien). Surface hemostasis was controlled using bipolar graspers. Operative time of the hepatectomy was 114 minutes. Cholecistectomy was done due to cholelithiasis. The third procedure consisted in performing a standard oncological sigmoidectomy. Inferior mesenteric artery was sectioned at the root of the left colic artery which one was preserved. Both hepatic and colonic specimens were removed throught a suprapubic transversal 5 cm incision. Operative time of the colonic procedure was 162 minutes. Total minimally invasive procedures time was 320 minutes. Postoperative,haemoglobin was 11.9 gr/dl (preoperative 13.9 gr/dl). The patient was discharged on 4th postoperative day without any incidence. Conclusions: Multiple simultaneous minimally invasive procedures can be combined in one time for the treatment of stage IV CC.
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