A Short-Interval Laparoscopic Liver-First (“Short-Cut”) Strategy for Synchronous Colorectal Liver Metastases: A Prospective Series

Objectives: To evaluate the short-interval laparoscopic reverse strategy (Short-Cut), performing colorectal resection within 1 week after hepatectomy for synchronous colorectal liver metastases (SCRLM). Patients and methods: Eligible criteria for the short-cut laparoscopic strategy were: (1) SCRLM of sufficient extent or complexity to make a combined colorectal and hepatic resection inappropriate; (2) no extrahepatic disease; (3) an asymptomatic colon or upper rectal primary; (4) a patient able to tolerate 2 major surgical procedures within a short interval; and (5) all hepatic lesions resectable through a single-stage laparoscopic hepatectomy and colorectal resection resected by laparoscopy. Perioperative outcomes, cumulative morbidity, timing of adjuvant chemotherapy resumption, and early oncological outcomes were analyzed. Results: Fifteen patients were included, of whom 9 required Institut Mutualiste Montsouris grade II–III hepatectomy. Posthepatectomy morbidity rate was 13%, including 1 late biliary fistula requiring endoscopic drainage after colorectal resection. The latter was performed after a median interval of 9 (8–12) days with a postoperative morbidity of 40%, including 13% major complications. Cumulative 90-day morbidity was 53% with a median total hospital stay of 16 days. All patients completed the strategy. Fourteen patients resumed adjuvant chemotherapy. After a median follow-up of 51 (3–92) months, recurrence occurred in 4 patients, and no deaths were observed. Conclusions: The Short-Cut laparoscopic strategy for SCRLM is feasible and safe in selected patients, preserving the liver-first oncological rationale, shortening the interval between procedures, and avoiding the morbidity of simultaneous major resections. Larger comparative studies are required to determine its impact on long-term oncological outcomes.