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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2020; 26(42): 6529-6555
Published online Nov 14, 2020. doi: 10.3748/wjg.v26.i42.6529
Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases: Between conventional and mini-invasive approaches
Emilio De Raffele, Mariateresa Mirarchi, Dajana Cuicchi, Ferdinando Lecce, Riccardo Casadei, Claudio Ricci, Saverio Selva, Francesco Minni
Emilio De Raffele, Saverio Selva, Division of Pancreatic Surgery, Department of Digestive Diseases, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy
Mariateresa Mirarchi, Dipartimento Strutturale Chirurgico, Ospedale SS Antonio e Margherita, 15057 Tortona (AL), Italy
Dajana Cuicchi, Ferdinando Lecce, Surgery of the Alimentary Tract, Department of Digestive Diseases, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy
Riccardo Casadei, Claudio Ricci, Francesco Minni, Division of Pancreatic Surgery, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
Author contributions: De Raffele E contributed to conception and design of the study, acquisition, analysis and interpretation of data, and wrote the manuscript; Mirarchi M contributed to conception and design of the study, acquisition, analysis and interpretation of data; Cuicchi D, Lecce F, Casadei R, Ricci C and Selva S contributed to the analysis, and interpretation of data; Minni F critically revised the manuscript; All authors have read and agreed to the present version of this manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Emilio De Raffele, MD, PhD, Division of Pancreatic Surgery, Department of Digestive Diseases, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Via Albertoni 15, 40138 Bologna 40138, Italy. e.deraffele@aosp.bo.it
Received: July 12, 2020
Peer-review started: July 12, 2020
First decision: September 12, 2020
Revised: October 5, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: November 14, 2020
Abstract

The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under debate. Staged approach, with initial colorectal resection followed by liver resection (LR), or even the reverse, liver-first approach in specific situations, is traditionally preferred. Simultaneous resections, however, represent an appealing strategy, because may have perioperative risks comparable to staged resections in appropriately selected patients, while avoiding a second surgical procedure. In patients with larger or multiple synchronous presentation of colorectal cancer and liver metastases, simultaneous major hepatectomies may determine worse perioperative outcomes, so that parenchymal-sparing LR should represent the most appropriate option whenever feasible. Mini-invasive colorectal surgery has experienced rapid spread in the last decades, while laparoscopic LR has progressed much slower, and is usually reserved for limited tumours in favourable locations. Moreover, mini-invasive parenchymal-sparing LR is more complex, especially for larger or multiple tumours in difficult locations. It remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or if we need further technological advances and surgical expertise, at least for more complex procedures. This review aims to critically analyze the current status and future perspectives of simultaneous resections, and the present role of the available mini-invasive techniques.

Keywords: Synchronous colorectal liver metastases, Colorectal surgery, Liver surgery, Simultaneous resection, Parenchymal-sparing liver resection, Mini-invasive surgery, Intraoperative ultrasonography

Core Tip: The optimal timing of surgery in case of synchronous colorectal cancer and liver metastases is debated. Staged approaches are traditionally preferred, but simultaneous resections are increasingly performed in appropriately selected patients. Since major liver resections (LR) may determine worse perioperative outcomes, parenchymal-sparing LR should be considered whenever feasible. While mini-invasive colorectal surgery is widely diffused, mini-invasive LRs are usually reserved for limited tumours in favourable locations, and parenchymal-sparing LR is more complex. It remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or further technological advances and surgical expertise are needed, at least for more complex procedures.