Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases: Between conventional and mini-invasive approaches

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.