Purpose: The ideal timing for patients with colorectal cancer to undergo surgery for resectable synchronous liver metastases remains under debate. We describe a new sequential approach using laparoscopic/robotic surgery for the treatment of synchronous liver metastases.
Methods: A 73-year-old man presented with sigmoid cancer and a single 8-cm right liver metastasis. A staged sequential minimally invasive approach was planned. A laparoscopic left colectomy was performed first, followed by a robotic right hepatectomy 10 days later.
Results: The left colectomy lasted 120 min with a negligible blood loss (<10 mL). The right hepatectomy was completed robotically with an operating time of 330 min and intraoperative blood loss of 300 mL. The postoperative course was uneventful and the patient was discharged at postoperative day 8 of the liver resection. Three weeks later, the patient received adjuvant chemotherapy. At 26-months follow up, the patient was alive without recurrence.
Conclusions: This report suggests the technical feasibility and safety of a sequential totally minimally invasive approach for synchronous colorectal liver metastases. In selected patients, this approach can avoid the risk of a synchronous associate major liver/colonic resection using the advantages of minimally invasive surgery.