MINIMALLY INVASIVE SURGERY IN TREATMENT OF PATIENTS WITH METASTATIC COLORECTAL CANCER

Purpose of the study. Was to improve the results of treatment for metastatic colorectal cancer using laparoscopic surgical technologies.

Patients and methods. We analyzed the data on 311 patients aged 44–78 years with colorectal cancer and liver metastases; in 2005–2015, all patients received treatment at National Medical Research Centre for Oncology of the Ministry of Health of Russia. The main group included 161 patients with metastatic colon cancer and resectable liver metastases receiving laparoscopic surgery; 150 patients with the same disease receiving open surgery were controls.

Results. The study demonstrated that laparoscopy with a combination of developed surgical techniques significantly (р<0.05) reduced the number of surgical complications in the main group (1.8%) compared to controls (12.8%). Patients with metastatic colorectal cancer receiving laparoscopy demonstrated higher, compared to patients with standard open surgery, relative risks of cardiovascular and respiratory complications (HR=4.7, р=0.001), thrombohemorrhagic complications (HR=2.8, р=0.05) and arrhythmia (HR=3.73, р=0.07), but lower risks of surgical complications (HR=0.13, р=0.001). Survival of patients with metastatic colorectal patients was statistically significantly higher in the main group compared to controls: log‑rank test = 2.11 at р=0.035.

Conclusions. Laparoscopy reduced the number of surgical complications, compared to open surgery. However, patients with comorbid pathologies showed higher relative risks of other complications.

1. Adam R, de Gramont A, Figueras J, Kokudo N, Kunstlinger F, Loyer E, et al. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev. 2015 Nov; 41(9): 729–741. https://doi.org/10.1016/j.ctrv.2015.06.006

2. Cheung TT, Poon RTP. Synchronous resections of primary colorectal tumor and liver metastasis by laparoscopic approach. World Journal of Hepatology. 2013 Jun 27; 5(6): 298–301. https://doi.org/10.4254/wjh.v5.i6.298

3. Eadens MJ, Grothey A. Curable metastatic colorectal cancer. Curr Oncol Rep. 2011 Jun; 13(3): 168–176. https://doi.org/10.1007/s11912–011–0157–0

4. Kit OI, Gevorkyan YuA, Soldatkina NV, Kolesnikov VE, Kharagezov DA, Dashkov AV, et al. Minimally invasive technologies in the complex treatment of colorectal cancer with liver metastases. Coloproctology. 2014; S3(49): 65–66. (In Russian).

5. Papa A, Rossi L, Lo Russo G, Giordani E, Spinelli GP, Zullo A, et al. Emerging role of cetuximab in the treatment of colorectal cancer. Recent Pat Anticancer Drug Discov. 2012 May 1; 7(2): 233–247. https://doi.org/10.2174/157489212799972882

6. Tsujii M. Search for novel target molecules for the effective treatment or prevention of colorectal cancer. Digestion. 2012; 85(2): 99–102. https://doi.org/10.1159/000334678

7. Alekhnovich VYu, Prokhorov AV. Comparative analysis of comprehensive treatment of metastatic colorectal cancer. Medical Journal. 2018; 2 (64): 21–26. (In Russian).

8. Kit OI, Gevorkyan YuA, Kolesnikov VE, Soldatkina NV, Kharagezov DA, Kaimakchi OYu. Laparoscopic combined resection of sigmoid colon, panhysterectomy with removal through vagina stump. Pirogov Russian Journal of Surgery Surgery. Journal named after N. I. Pirogova. 2014;(11): 63–65. (In Russian).

9. Kit OI, Gevorkyan YuA, Soldatkina NV, Kharagezov DA, Kolesnikov VE, Milakin AG. Multiple primary colorectal cancer: the possibilities of minimally invasive surgical interventions. Coloproctology. 2017; 1(59): 38–42. (In Russian).

10. Efanov MG, Alikhanov RB, Tsvirkun VV, Kazakov IV, Kim PP, Van'kovich AN, et al. Early and Long‑term Outcomes of Laparoscopic and Robot‑assisted Liver Resections. Specialized Center’s Experience. Annals of HPB Surgery. 2018; 23(1): 38–46. (In Russian). https://doi.org/10.16931/1995–5464.2018138–46

11. Kit OI, Gevorkyan YuA, Soldatkina NV, Kolesnikov EN, Kolesnikov VE, Kozhushko MA, et al. Combined surgery for locally advanced colorectal cancer. Pirogov Russian Journal of Surgery Khirurgiya. Zhurnal imeni N. I. Pirogova. 2016;(11): 42–47. (In Russian). https://doi.org/10.17116/hirurgia20161142–47

12. Hoekstra LT, Busch ORC, Bemelman WA, van Gulik TM, Tanis PJ. Initial experiences of simultaneous laparoscopic resection of colorectal cancer and liver metastases. HPB Surg. 2012; 2012: 893956. https://doi.org/10.1155/2012/893956

13. Hatwell C, Bretagnol F, Farges O, Belghiti J, Panis Y. Laparoscopic resection of colorectal cancer facilitates simultaneous surgery of synchronous liver metastases. Colorectal Dis. 2013 Jan; 15(1): e21–28. https://doi.org/10.1111/codi.12068

14. Gunka I, Dostalik J, Martinek L, Gunkova P, Mazur M, Vavra P. Long‑term results of laparoscopic versus open surgery for nonmetastatic colorectal cancer. Acta Chir Belg. 2012 Apr; 112(2): 139–147. https://doi.org/10.1080/00015458.2012.11680812

15. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short‑term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013 Mar; 14(3): 210–218. https://doi.org/10.1016/S1470–2045(13)70016–0

16. Slesser AAP, Simillis C, Goldin R, Brown G, Mudan S, Tekkis PP. A meta‑analysis comparing simultaneous versus delayed resections in patients with synchronous colorectal liver metastases. Surg Oncol. 2013 Mar; 22(1): 36–47. https://doi.org/10.1016/j.suronc.2012.11.002