Two Cases Of Simultaneous Laparoscopic-assisted Resection Of Colorectal Cancer With Liver Metastases And Relevant Literature Analysis

Background:Colorectal cancer is one of the most common gastrointestinal cancer and it's morbidity worldwide has been rising in recent decades.The patients would only have about 0-5%of the survival rate if without any treatments.Many studies have demonstrated that about 1/3 of the patients who are initially diagnosed as colorectal cancer have been under the stage of synchronous metastases.And 50%of these patients have liver metastases,which is the leading cause of the failure of treatments for colorectal cancer.Although there is no specific regulation about the treatments of colorectal cancer with liver metastases,surgery of resection of primary lession and liver lession has been adapted by more and more clinicians.Meantime,some alternative therapies have been well developed such as radiofrequency ablation(RFA),percutaneous ethanol injection(PEI),acetic acid injection,microwave coagulation,and transcatheter arterial chemoembolization(TACE).Besides,systemic chemotherapy,which has been conventionally used for carcinomas,is also widely applied to colorectal cancer.However,there are still many debates about whether systemic chemotherapy and other treatments like RFA should be used or not for colorectal cancer with liver metastases during perioperative period.Method:Case 1 was a 48-year-old man with founding rectum and liver occupying lesions for 1 week,receiving laparoscopic radical resection of rectal carcinoma,left lateral lobe liver and right lobe liver metastases lesions with one subcostal incision and finally survived for 4 years and 1 month.Case 2 was a 48-year-old man with diarrhea for 6 months and bloody stool for 2 months,receiving laparoscopic radical resection of rectal carcinoma and left liver and was followed up for 8 years and 2 months.Two patients were diagnosed as colorectal cancer with liver metastases and received the surgery of simultaneous laparoscopic resection of primary lession and liver lession.After surgery,case 1 patient took nearly 20 circles of systemic chemotherapy and many times of RFA and PEI and finally survived for 4 years,while case 2 patient didn't take any treatment due to the personal reasons and was finally followed up for 8 years.The similar conditions about two patients lead to two different prognosis,which should be considered seriously.Comparing and analyzing the results of examinations and the process of treatments from two patients as well as combining with relevant surveys and literatures,we considered that simultaneous resection of colorectal cancer with liver metastases is the first choice if possible and laparoscopic surgery can reduce operative trauma.One clinical case from us indicates that patients could receive good long-survival after surgery without any other adjuvant treatments.Conclusion:Simultaneous resection of colorectal cancer with liver metastases is the first choice if it is possible for patients.It is eligible for simultaneous laparoscopic-assisted resection of primary lession and liver lession with one incision.And selective patients with liver metastases of colorectal cancer could receive good long-survival after surgery without any other adjuvant treatments.