Reply to: Surgical treatment of metachronous rectal liver and lung metastases: A combined videolaparoscopic and videothoracoscopic approach
Daniele Del Fabbro a, GuidoTorzilli a,b,*
a Department of Hepatobiliary Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
b Humanitas University, School of Medicine, Rozzano, Milan, Italy ∗Corresponding author.
E-mail address: guido.torzilli@humanitas.it (G. Torzilli)
Abstract：The Author Reply:
We thank Dr. Sucameli et al. for the interest toward our article [1] and for the opportunity for further discussing on this issue, providing a case report of single metastastic fore sites in the liver and lung both treated in a minimal access fashion. However, given the interest of the authors insight, it appears misleading when related to that discussed in our report which was clearly referred to other patients’ profiles. Indeed, they described a case with a single peripheral nodule in the right lung and a single liver metastases in segment 5. This uncommon situation (less than 2% of patients according to the LiverMetSurvey registry [2]), is obviously a more than reasonable indication for a mini-invasive approach. However, our patients received surgery for complex oncological involvement of the liver: as described, this means large and/or multiple lesions, in contact or invading the hepatic veins at caval confluence. For such conditions we have introduced original surgical approaches [3,4]: in such conditions we would select a J-shaped thoracophrenolaparotomy for the liver per se [5]. This incision for such complex conditions other than allowing the liver clearance in a single operation rather than in staged approach [6], allows just in case the removal of lung nodules. Therefore, we thank again the authors for their interest to our report, and furthermore we congratulate for the original management of the shared clinical case. However, the condition recalled by the authors is related to a scenario oncologically and surgically at the opposite side of that discussed in our paper and for that somehow suggesting a comparison is misleading.
2018, Vol. 17 
