Laennec's approach for central liver resection of colorectal cancer liver metastasis adjacent to the hepatic hilum that occurred 10 years after colectomy: A case report.

INTRODUCTION AND IMPORTANCE: Colorectal cancer ranks as one of the most common cancer globally. About half of the patients experience a disease recurrence in the form of сolorectal cancer liver metastasis (CRLM) within the first 5 years of the course of the disease. However, there are rare cases of delayed onset of liver metastasis, that occur after cessation of standard follow-up. CASE PRESENTATION: A 38-year-old woman was referred to our institute with a metastatic liver mass adjacent to the liver hilum. The patient had sigmoid colectomy 10 years ago. After 6 cycles of chemotherapy, she underwent a central liver resection: Sg4, Sg5, Sg8v + middle hepatic vein with surgical skeletonization of 1st and 2nd order hepatic pedicles. The patient was discharged on 5th post-operative day. After 18th month of follow-up, the patient was alive without any signs of recurrence. CLINICAL DISCUSSION: The recommended follow-up of colorectal cancer patients is 5 years. However, there are rare instances of late metachronous liver recurrences, that suggest the necessity of more continuous surveillance. For patients with CRLM surgical resection is considered the most radical treatment of choice. The anatomy of Laennec's capsule allows the precise isolation of hepatic pedicles and can facilitate anatomical hepatectomy. CONCLUSION: We present a rare case report of borderline-resectable CRLM successfully treated with central liver resection with application of Laennec's approach a decade after the resection of a primary colorectal tumor.

Laparoscopic and Open Liver Resections for Colorectal Cancer Liver Metastasis in the Ukrainian State Center.

Background Minimally invasive liver resections for metastatic colorectal cancer have been increasingly performed all over the world with promising results. We planned the current study to review our experience on this matter and compare short- and long-term outcomes of laparoscopic liver resection (LLR) and open liver resection (OLR) in patients with colorectal cancer liver metastasis (CRLM). Materials and methods This is a single-center retrospective analysis of patients with CRLM who underwent laparoscopic (n=86) and open (n=96) surgical treatment for metastatic liver lesions between March 2016 and November 2022. Tumor characteristics, intra- and postoperative results, overall survival (OS), and disease-free survival (DFS) were analyzed and compared. Results LLR was associated with significantly shorter surgery duration (180 minutes versus 295 minutes, p=0.03). There was no significant difference in blood loss between the two groups (100 mL versus 350 mL, p=0.061). Additionally, the laparoscopic approach was associated with significantly shorter hospital stays (6 days versus 9 days, p=0.004). The rate of major complications (Clavien-Dindo classification ≥ 3) was lower in the LLR group (5.8% versus 16.6%, p=0.037). There was no mortality in the LLR group, and in the OLR group, one lethal case was induced by mesenteric thrombosis on the fifth postoperative day. We did not find a statistically significant difference in the OS rate between the two groups at one, three, and five years: 97.3%, 74.7%, and 43.4%, respectively, in the OLR group and 95.1%, 70.3%, and 49.5%, respectively, in the LLR group (p=0.53). DFS at one, three, and five years were 88.7%, 52.3%, and 25.5%, respectively, in the LLR group and 71.9%, 53.1%, and 19.3%, respectively, in the OLR group (p=0.66). Conclusions This study showed that laparoscopic liver surgery is a safe and effective method of CRLM treatment in our center. LLR was associated with a decrease in major morbidity, shorter surgery duration, and reduced postoperative hospital stay. Minimally invasive liver resections showed similar oncological outcomes to the open approach in terms of overall and disease-free survival.

Twenty-year experience in liver surgery in metastatic colorectal patients: a case series study in Ukraine.

For the last three decades, the world surgical community successfully adopted different surgical strategies for colorectal cancer (CRC) patients with liver metastases (LM), however, we are still seeing the evolution of treatment guidelines. The purpose of the study was to analyze a 20-year evolution of CRC patients with LM being treated in a specialized state Ukrainian oncological center. Materials and methods: The retrospective analysis of 1118 CRC patient cases using prospectively collected patient data from the National Cancer Institute registry. The time ranges between 2000-2010 and 2011-2022 and the LM manifestation - metachronous (M0)/synchronous (M1) were the two main grouping criteria. Results: The overall survival 5-year survival of patients who had surgery between 2000-2011 and 2012-2022 was 51.3 and 58.2% (P=0.61) for the M0 cohort and 22.6 and 34.7% at M1 (P=0.002), respectively. The results of the multivariate analysis in 1118 cases revealed that liver re-resection and regional lymph node dissection ≥D2 were associated with better overall survival [hazard ratio (95% CI)=0.76 (0.58-0.99) P=0.04] in the M0 cohort and receiving at least 15 courses of chemotherapy had better recurrence-free survival rates [hazard ratio (95% CI)=0.97 (0.95-0.99), P=0.03] for both M0 and M1. Conclusions: It was shown the improvement of the oncological prognosis for CRC patients with synchronous LM who were treated after 2012. The adaptation of world experience algorithms and the surgical strategy evolution have become the root cause of the above.

Impact of the Pringle manoeuvre on the mitochondrial redox state of hepatocytes in colorectal cancer patients with liver metastases.

INTRODUCTION: Novel surgical strategies for metastatic colorectal cancer (CRC) treatment offer survival benefits even in the case of multiple bilobar liver injury. However, an inability to overcome the biological consequences of an ischaemia-reperfusion phenomenon among cancer patients remains an oncological issue throughout the last 3 decades. The aim of this study was to assess the values of molecular markers of the mitochondrial redox state of hepatocytes in CRC patients during liver surgery and Pringle manoeuvre (PM) application. MATERIAL AND METHODS: We conducted a prospective study of 114 CRC patients who underwent liver resection for CRC metastases between March 2017 and December 2020. RESULTS: PM application was associated with higher superoxide radicals (SR) level generation compared to liver surgery without blood inflow control - 0.32 ± 0.12 and 0.42 ± 0.21 nmol/gm raw tissue × min, respectively. Levels of NO-Fe-S cluster protein complexes in liver stump parenchyma in the end of transection with and without PM was 0.35 ± 0.09 RU and 0.16 ± 0.04 RU, respectively. The most significant impact of long-term ischaemia was found to be the rate of SR generation in liver stump: 152.4 ± 24.4 (95% CI: 104.1-200.7), R2 = 0.46, p = 0.001. CONCLUSIONS: PM exacerbates the disruption of the mitochondrial respiratory chain and potentiates SR generation. The redox status molecular markers of the hepatocytes in CRC patients with liver metastases can be used to assess the functional status of organ and tissues and improve the existing surgical strategies.

Systematic extended posterior right sectionectomy with simultaneous resection of the dorsal part of segment 1 and middle hepatic vein detachment.

Parenchymal sparing surgery should be the strategy of choice for patients with bilobar liver metastases and lesions within the central liver sites.

Parenchyma sparing multicomponent liver resection strategy for multiple bilobar synchronous colorectal cancer metastasis.

A two-stage multicomponent parenchymal sparing surgical strategy (anatomical extended on left hepatic vein 2-nd segment liver resection and R1vascular approach) allows the successful resection of synchronous multiple bilobar CRC metastases.

Resection and simultaneous reconstruction of the infrarenal aorta and inferior vena cava (case report).

A non-standard surgicall approach in malignant retroperitoneal tumor treatment was used, which includes simultaneous resection and reconstruction of the infrarenal segment of aorta and inferior vena cava. The total vascular recunstrustion time was 40 minutes and 15 minutes out of total time was arterial ischemia. The postoperative period was complicated by the right urethral fistula and the limited fluid concentration in the surgical area. On day 25th of the post-operative period patient discharged from the hospital. We believe that such a tactic can be safe and effective in case of meticulous patients selection and the multidisciplinary and multi-team approaches application.