Kim et al. (23) reported on their initial experience with 10 patients with colorectal cancer and ABT-263 chemical structure synchronous liver metastases in order to assess the feasibility of a minimally invasive approach to synchronous disease. The primary tumors were resected via anterior or low anterior resection in eight patients, right hemicolectomy in one patient, and subtotal Inhibitors,research,lifescience,medical colectomy in one patient. Major hepatectomies were performed in six patients.

There were no perioperative deaths. One patient developed postoperative bleeding requiring open re-exploration. The authors concluded that a synchronous minimally invasive approach was feasible in selected patients with colorectal cancer and hepatic metastases. Akiyoshi (24) also published their results following synchronous laparoscopic resection in 10 patients. All primary tumors were located Inhibitors,research,lifescience,medical in the sigmoid or rectum. Seven of their patients had an open hepatic resection following their laparoscopic colorectal resection and three patients underwent

a minimally invasive resection for an isolated hepatic metastasis. There was no postoperative mortality and one patient developed a complication unrelated to the colorectal or hepatic resection. The open technique required for the hepatic resections limits the significance of this Inhibitors,research,lifescience,medical study but provides some insight into the safety of hybrid laparoscopic resections for synchronous colorectal cancer. Lee et al. (25) recently published their 10 patient series of laparoscopic simultaneous Inhibitors,research,lifescience,medical colorectal and hepatic resection. Primary tumors were right-sided in four patients, left-sided in three cases, and rectal in three cases. Six patients had single hepatic metastases while the other four patients had ≥2 hepatic metastases. One patient underwent a right hemihepatectomy while others underwent minor hepatic resections. One case required conversion to

an open approach due to bleeding from a hepatic Inhibitors,research,lifescience,medical vein and this patient also developed an anastomotic leak. There were no postoperative mortalities. This study provides additional limited support for a simultaneous minimally invasive approach for colorectal cancer with limited hepatic metastases. The largest study to date on simultaneous minimally invasive resection of colorectal cancer with hepatic metastases was published by Huh et al. (26). In their study, they compared 20 patients who underwent during laparoscopic colorectal resection with 20 patients who had an open approach. In all cases, after the colorectal was completed (either laparoscopically or open), hepatic resection was performed, either laparoscopically or via laparotomy. There were no differences between the laparoscopic and open colectomy groups with regard to the extent of hepatic disease. Minor hepatectomies were performed in 95% of the laparoscopic group and 75% of the open colectomy group.