herein , we describe a case of colon cancer and synchronous liver metastasis in which both tumours were treated laparoscopically . a 70-year - old woman was admitted to our hospital with a diagnosis of cancer of the sigmoid colon . barium enema showed an encircling mass in the sigmoid colon [ figure 1 ] . computed tomography ( ct ) revealed a low - density area in the left lateral segment of the liver [ figure 2 ] . liver function was normal , and the pre - operative carcinoembryonic antigen level was 6.2 ng / ml ( normal range , < 5 ng / ml ) . we planned two - stage procedure for the patient because it was considered to be a highly invasive treatment for this elder patient when both sigmoid colectomy and hepatectomy were performed simultaneously . in addition , interval hepatic resection for synchronous metastases of colorectal cancer , with a routine waiting period of 46 months , was recommended to improve the patient selection . therefore , laparoscopic sigmoid colectomy was performed first . with the patient in the supine position , pneumoperitoneum of 8 mmhg was established , and trocars were placed in the right upper and lower abdomen [ figure 1 ] . after the sigmoid colon was mobilised from the surrounding tissues , a skin incision ( 6 cm ) was made in the left lower abdomen . the sigmoid colon was exteriorised and resected through the skin incision after appropriate barrier protection of the wound edges was ensured . the post - operative course was uneventful , first flatus was recognised on day 2 , solid diet was started on day 3 , the patient was discharged and directly went home on post - operative day 11 . ( a ) barium enema shows an encircling tumuor in the sigmoid colon ( arrows ) ( b ) port sites for laparoscopy assisted sigmoid colectomy ( a ) computed tomographic scan shows a metastatic liver tumour ( arrow ) ( b ) port sites for laparoscopic partial hepatectomy five months after the first operation , ct scan revealed that the slight enlargement of the liver tumour ( 2537 mm in diameter ) , but new lesions were not observed [ figure 2 ] . after co2 insufflation with a pressure of 8 mmhg , inspection of the peritoneal cavity revealed no remarkable adhesion . the falciform , left triangular and coronary ligaments were dissected , and the left hepatic lobe was mobilised . hepatic resection was performed with an endoscopic autosuture stapler ( endogiaii , us surgical , norwalk , ct , usa ) under lower pneumoperitoneum pressure to prevent gas embolism . the resected specimen was removed from the port site , which was enlarged to 3 cm in the supraumbilical area with an endocatchii device ( us surgical ) . the post - operative course was uneventful and the patient was discharged and directly went home on day 14 . she is currently doing well , with no evidence of disease recurrence during the 8 months since the procedure . further development of instruments and techniques has made it possible to apply laparoscopic surgery to malignant diseases . to our knowledge , this is the first report of laparoscopic resection of both primary tumour and metastatic liver tumour . in comparison to conventional surgery , laparoscopic surgery is beneficial with respect to short - term outcome , including earlier recovery and less pain . our research in a murine model has shown that laparoscopic surgery is advantageous for gastrointestinal malignancies due to reduced impairment of systemic and intraperitoneal cell - mediated immune responses . although a comparison of long - term outcomes between laparoscopic and conventional surgeries for advanced colon cancer has been recently published , there have been no reports of randomised trials of laparoscopic hepatectomy in patients with metastatic liver tumours .
we report herein the case of 70-year - old woman in whom colon cancer and a synchronous metastatic liver tumour were successfully resected laparoscopically . 
 the tumours were treated in two stages . 
 both post - operative courses were uneventful , and there has been no recurrence during the 8 months since the second procedure .