A major limitation to the majority of available studies, however, is the variable extent of disease present among patients subjected to a simultaneous compared to a staged resection approach. Only the study by Moug et al. (19) attempted to address this issue. Based upon their limited case-matched study, the oncologic equivalence seen among the larger studies Inhibitors,research,lifescience,medical available appears to be sustained. The “Reverse Strategy” approach (5) is interesting insofar as it provides an approach
which allows for extensive hepatectomies to be performed safely in a select group of patients with asymptomatic primary colorectal tumors. The authors have found that this approach helps increase resectability in patients not initially considered candidates for resection and avoids the delay off chemotherapy
Inhibitors,research,lifescience,medical following initial colorectal resection which may allow for hepatic progression. It is noteworthy that the authors routinely give chemotherapy to all patients with synchronous resection colorectal liver metastases as this is not the routine practice amongst some surgeons who advocate a simultaneous resection for resectable colorectal hepatic metastases. Table 3 Oncologic outcomes following synchronous and staged resections. Role Inhibitors,research,lifescience,medical of minimally invasive approaches to synchronous colorectal cancer with hepatic metastases The safety and efficacy of minimally invasive approaches to colorectal disease, including cancer, was Selleck ZD6474 established following the report of the Clinical Outcomes of Surgical Therapy (COST) trial (21) which showed equivalent Inhibitors,research,lifescience,medical recurrence and overall survival rates between patients who underwent laparoscopically-assisted compared to open resection for colon cancer. An increase in minimally invasive Inhibitors,research,lifescience,medical hepatic resections has paralleled and followed the increased use of minimally invasive approaches to colorectal malignancies. A recent report by Nguyen et al. (22) retrospectively reviewed all cases of minimally invasive hepatectomy for colorectal liver metastases performed in the United States and Europe between 2/2000 – 9/2008. A total of 109 cases were included in the review. Synchronous
hepatic lesions were present in 11%. The median interval between resection of the colorectal primary and hepatic resection was 12 months among metachronous patients. Minor hepatectomies (≤3 segments) were performed in about 61.5% of patients. The overall complication rate was 12% with no perioperative deaths. Negative margin resections were achieved in 94%. Actuarial overall survival was 88% at one year, 69% at three years, and 50% at 5 years. Disease-free survival for 1-, 3- and 5-years were 65%, 43%, and 43%, respectively. Based upon their review, Nguyen et al. (22) concluded that minimally invasive liver resections for colorectal metastases were feasible and could be performed safely with acceptable safety and oncologic outcomes.