• ScientiFic articleS •
Simultaneous Liver Metastasectomy at Operation for Primary Colorectal or Gynecologic Malignancy J. Jarrett Corley, MD; Mary Kinney Corley, MD; Christopher J. Lahr, MD; David G. McIntosh, MD; Mildred Ridgway, MD and Naveed A. Ahmed, MD
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Background: Treatment of synchronous resectable colorectal liver metastases has traditionally involved a staged surgical approach. Specialized centers have demonstrated good results with simultaneous resection. We aim to report our outcomes at the University of Mississippi Medical Center (UMMC) with simultaneous liver metastasectomy at the time of operation for primary colorectal or gynecologic malignancy Study deSign: From January 2010- September 2011, 6 patients underwent simultaneous resection of liver metastases and primary colorectal or gynecologic malignancy. Operative, postoperative, and pathologic data were retrospectively reviewed. reSultS: Four patients with colorectal primaries underwent simultaneous resection. One received abdominoperineal resection with resection of lesions in hepatic segments II and VII. A second received right hemicolectomy with en bloc resection of gallbladder and segments IV and V. The third and fourth patients both underwent left colectomy with resection of segments IV and V, respectively. All resections were nonanatomic, and frozen-sections were confirmed to be negative at the resection base. No patients suffered additional postoperative morbidity or mortality related to liver resection.
AutHor AffiliAtionS: Resident, Department of General Surgery (Dr JJ Corley), Resident, Department of Obstetrics and Gynecology (Dr MK Corley). Colorectal surgeon, Department of Surgery, (Dr Lahr). Department of Obstetrics and Gynecology, specialized training in gynecologic oncology (Drs McIntosh and Ridgway). Department of Surgery, specialized training in hepatobiliary surgery (Dr Ahmed).University of Mississippi Medical Center, Jackson, MS. correSPonding AutHor: Naveed Ahmed, MD, 2500 North State Street, Department of Surgery, University of Mississippi Medical Center, Jackson, MS 39216. (601)984-5120. (nahmed@umc.edu).
36 JOURNAL MSMA
February 2012
Two patients had ovarian cancer with metastatic disease to the liver. The first underwent en bloc resection of gallbladder and segments IV and V along with extensive debulking. The second had recurrent ovarian cancer with metastases with liver segments VI and VII. Both patients underwent simultaneous resection with no added postoperative morbidity or mortality attributed to hepatic resection. For gynecologic malignancy, the objective is to remove bulky disease, and although microscopic margins were positive, the goal of tumor load reduction was achieved. concluSionS: Liver resection at the time of operation for primary colorectal or gynecologic primary can safely be performed with the benefit of avoiding morbidity of a second laparotomy without compromising safety. key WordS:
Stage IV colorectal cancer; HepatIc metaStaSectomy; cytoreductIVe tHerapy for oVarIan cancer.
introduction Approximately 25% of patients with colorectal cancer present with synchronous hepatic metastases- a subset of patients that may encompass nearly 35,000 people annually.1 Survival in stage IV colorectal cancer has traditionally approached 10%, and the mainstay of treatment has been systemic chemotherapy. Surgical resection of liver metastases remains the only potentially curative therapy with five-year survival rates of nearly 25% reported in the literature.2-6 Treatment of synchronous resectable colorectal liver metastases has traditionally involved a staged approach with resection of the primary cancer followed by metastasectomy 2-6 months later.7-11 Some highly-specialized, high-volume centers have demonstrated good results with simultaneous resection, reporting a perioperative mortality <5%.4,12-16 Similarly, resection of liver metastases during cytoreductive surgery for ovarian cancer favorably affects survival.17-19