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Simultaneuos laparoscopic resection of colorectal cancer and liver metastases
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E-AHPBA: Poster Abstracts
LIVER 0155 SIMULTANEUOS LAPAROSCOPIC RESECTION OF COLORECTAL CANCER AND LIVER METASTASES N. V. Belev, P. St Rusev, M. T. Slavchev, N. Schopov and S. N. Popov Eurohospital-Plovdiv, Bulgaria Aims: Synchronous liver metastases (SLMs) are found in 15%e25% of patients at the time the presentation with colorectal cancer, which is limited to the liver in 30%. Surgical resection is the most effective and potential curative therapy for metastatic colorectal carcinoma (CRC) to the liver. Simultaneous resection of primary CRC and synchronous liver metastases is subject of debate with respect to morbidity in comparison to staged resection. Minimally invasive laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens hospitalization, and yields superior cosmetic results, without compromising oncological outcome. The aim of this study is therefore to evaluate our initial experiences of simultaneous laparoscopic resection of primary CRC and SLM. Methods: Currently, laparoscopic resection of primary CRC is performed in more than 53% of all patients in our surgical department. 18 patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. 6 of them underwent laparoscopic colorectal resection combine by major laparoscopic liver resection. Results: Surgical approach was total laparoscopic (17 patients) or hand-assisted laparoscopic (1 patients). The incision created for the extraction of the specimen varied between 5 and 8cm. Median operation time was 245 (range 150e320) minutes with a total blood loss of 600 (range 200-750) ml. Postoperative hospital stay was 7day (5e12). An R0 resection was achieved in all patients. Conclusions: Simultaneous laparoscopic colorectal and liver resection appears to be save and feasible in selected patients with CRC and SLM, with satisfying short-term results.
LIVER 0181 SURGICAL TREATMENT OF THE HEPATOCELLULAR CARCINOMA WITH PORTAL VEIN INVASION O. G. Kotenko, O. O. Grinenko, O. O. Korshak, D. O. Fedorov, A. V. Gusev, O. O. Popov, M. S. Grigoryan and O. M. Ostapishen National Institute Of Surgery and Transplantology, Ukraine Aims: Mostly cases of an invasion or a tumoral thrombosis of a PV are considered as the nonresectable. We adapted the aggressive approach in treatment of the HCC complicated by an invasion or a thrombosis of bifurcation or a main trunk of a PV. The purpose of the present research was studying of results of a resection of a liver with a single-step resection of a portal vein at treatment of a HCC. Methods: 84 patients with a HCC undergoing liver resection from January 2003 till December 2013 was included in research. 22 patients with a PV thrombosis underwent
radical liver resections (R0) and have made the basic group. 62 patients were included in control group with a tumor thrombosis of branches of a PV 2e5 order. Results: At patients of the basic group are executed 14 expanded and 8 extended liver resections. In all cases of the basic group the total caudal lobectomy was executed. A resection of a PV was made in 2e3 mm from visible border of a tumor thrombus. We used 3 methods reconstruction of PV, mostly by end-to-end anastomosis. At patients of control group was executed 42 extensive, 14 expanded resections of a liver and 6 resections of two segments of a liver. Character and quantity of complications were similar in both groups except small for size syndrome, which authentically met in the basic group. The postoperative mortality till 30 days in the basic group was 9,1 % (2 patients), in control group - 8,1 % (5 patients). Conclusions: Aggressive surgical approach for HCC patients with a tumor PV thrombosis, including a resection of the part of a liver, a caudal lobectomy, a resection of the part of a PV allows to obtain satisfactory results with comprehensible level of a mortality and survival rate.
LIVER 0185 LIVER RESECTION FOR TREATMENT OF CHRONIC LIVER ABSCESSES O. G. Kotenko, A. V. Gusev, M. S. Grigoryan, O. V. Grinenko, M. Y. Kalita, D. O. Fedorov, O. O. Korshak, O. O. Popov and O. M. Ostapishen National Institute of Surgery and Transplantology, Ukraine Aims: Improve outcomes in patients with chronic liver abscess through the development and use of liver resection. Methods: The results of surgical treatment of 64 patients with chronic liver abscess. The indications for surgical treatment of patients with liver abscess were the clear fibrous capsule of the abscess and the poor treatment outcomes punctures or percutaneous drainage. Such abscesses we considered as chronic abscesses. All patients were divided into two groups: 1) 30 (46.8%) patients underwent different types of anatomical hepatectomy with an abscess, 2) 34 (53.2%) patients underwent surgical drainage of abscess of the liver. Results: Age of patients was 10e81 years, the average age was (41 13) years. The disease is more common in men 39 (60.9%) than in women 25 (39.1%). The most frequent chronic abscesses were located in the right lobe of the liver in 41 (64.4%) patients, the left lobe was struck in 13 (20.2%) patients, 10 (16.4%) cases - there has been lesion of both lobes. Of the 64 patients, 9 (14.0%) exceeded the abscess 15 cm, while 23 (35.9%) patients was 10e15cm lesion, 20 (31.2%) patients was 8e10 cm lesion , 12 (18.7%) patients had lesions within 5e8 cm. Postoperative complications occurred in 4 (13.3%) patients of the first group and 14 (41.1%) patients of the second group. Recurrence abscess occurred in 6 (17.6%) patients after surgical drainage. The postoperative period was in the first group was significantly lower than in patients of the second group and amounted to 15,1 0,7 and 27,3 3,05 days. Conclusions: Surgical treatment of chronic pyogenic liver abscesses entails an individual approach based on the
HPB 2016, 18 (S2), e685ee738
E-AHPBA: Poster Abstracts
LIVER 0155 SIMULTANEUOS LAPAROSCOPIC RESECTION OF COLORECTAL CANCER AND LIVER METASTASES N. V. Belev, P. St Rusev, M. T. Slavchev, N. Schopov and S. N. Popov Eurohospital-Plovdiv, Bulgaria Aims: Synchronous liver metastases (SLMs) are found in 15%e25% of patients at the time the presentation with colorectal cancer, which is limited to the liver in 30%. Surgical resection is the most effective and potential curative therapy for metastatic colorectal carcinoma (CRC) to the liver. Simultaneous resection of primary CRC and synchronous liver metastases is subject of debate with respect to morbidity in comparison to staged resection. Minimally invasive laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens hospitalization, and yields superior cosmetic results, without compromising oncological outcome. The aim of this study is therefore to evaluate our initial experiences of simultaneous laparoscopic resection of primary CRC and SLM. Methods: Currently, laparoscopic resection of primary CRC is performed in more than 53% of all patients in our surgical department. 18 patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. 6 of them underwent laparoscopic colorectal resection combine by major laparoscopic liver resection. Results: Surgical approach was total laparoscopic (17 patients) or hand-assisted laparoscopic (1 patients). The incision created for the extraction of the specimen varied between 5 and 8cm. Median operation time was 245 (range 150e320) minutes with a total blood loss of 600 (range 200-750) ml. Postoperative hospital stay was 7day (5e12). An R0 resection was achieved in all patients. Conclusions: Simultaneous laparoscopic colorectal and liver resection appears to be save and feasible in selected patients with CRC and SLM, with satisfying short-term results.
LIVER 0181 SURGICAL TREATMENT OF THE HEPATOCELLULAR CARCINOMA WITH PORTAL VEIN INVASION O. G. Kotenko, O. O. Grinenko, O. O. Korshak, D. O. Fedorov, A. V. Gusev, O. O. Popov, M. S. Grigoryan and O. M. Ostapishen National Institute Of Surgery and Transplantology, Ukraine Aims: Mostly cases of an invasion or a tumoral thrombosis of a PV are considered as the nonresectable. We adapted the aggressive approach in treatment of the HCC complicated by an invasion or a thrombosis of bifurcation or a main trunk of a PV. The purpose of the present research was studying of results of a resection of a liver with a single-step resection of a portal vein at treatment of a HCC. Methods: 84 patients with a HCC undergoing liver resection from January 2003 till December 2013 was included in research. 22 patients with a PV thrombosis underwent
radical liver resections (R0) and have made the basic group. 62 patients were included in control group with a tumor thrombosis of branches of a PV 2e5 order. Results: At patients of the basic group are executed 14 expanded and 8 extended liver resections. In all cases of the basic group the total caudal lobectomy was executed. A resection of a PV was made in 2e3 mm from visible border of a tumor thrombus. We used 3 methods reconstruction of PV, mostly by end-to-end anastomosis. At patients of control group was executed 42 extensive, 14 expanded resections of a liver and 6 resections of two segments of a liver. Character and quantity of complications were similar in both groups except small for size syndrome, which authentically met in the basic group. The postoperative mortality till 30 days in the basic group was 9,1 % (2 patients), in control group - 8,1 % (5 patients). Conclusions: Aggressive surgical approach for HCC patients with a tumor PV thrombosis, including a resection of the part of a liver, a caudal lobectomy, a resection of the part of a PV allows to obtain satisfactory results with comprehensible level of a mortality and survival rate.
LIVER 0185 LIVER RESECTION FOR TREATMENT OF CHRONIC LIVER ABSCESSES O. G. Kotenko, A. V. Gusev, M. S. Grigoryan, O. V. Grinenko, M. Y. Kalita, D. O. Fedorov, O. O. Korshak, O. O. Popov and O. M. Ostapishen National Institute of Surgery and Transplantology, Ukraine Aims: Improve outcomes in patients with chronic liver abscess through the development and use of liver resection. Methods: The results of surgical treatment of 64 patients with chronic liver abscess. The indications for surgical treatment of patients with liver abscess were the clear fibrous capsule of the abscess and the poor treatment outcomes punctures or percutaneous drainage. Such abscesses we considered as chronic abscesses. All patients were divided into two groups: 1) 30 (46.8%) patients underwent different types of anatomical hepatectomy with an abscess, 2) 34 (53.2%) patients underwent surgical drainage of abscess of the liver. Results: Age of patients was 10e81 years, the average age was (41 13) years. The disease is more common in men 39 (60.9%) than in women 25 (39.1%). The most frequent chronic abscesses were located in the right lobe of the liver in 41 (64.4%) patients, the left lobe was struck in 13 (20.2%) patients, 10 (16.4%) cases - there has been lesion of both lobes. Of the 64 patients, 9 (14.0%) exceeded the abscess 15 cm, while 23 (35.9%) patients was 10e15cm lesion, 20 (31.2%) patients was 8e10 cm lesion , 12 (18.7%) patients had lesions within 5e8 cm. Postoperative complications occurred in 4 (13.3%) patients of the first group and 14 (41.1%) patients of the second group. Recurrence abscess occurred in 6 (17.6%) patients after surgical drainage. The postoperative period was in the first group was significantly lower than in patients of the second group and amounted to 15,1 0,7 and 27,3 3,05 days. Conclusions: Surgical treatment of chronic pyogenic liver abscesses entails an individual approach based on the
HPB 2016, 18 (S2), e685ee738