Muratore Andrea, Zorzi Daria, Bouzari Hedayat, Amisano Marco, Massucco Paolo, Sperti Elisa, Capussotti Lorenzo
Division of Surgical Oncology, Istituto per la Ricerca e la Cura del Cancro, Candiolo (TO), Italy.
Ann Surg Oncol. 2007 Feb;14(2):766-70. doi: 10.1245/s10434-006-9146-1. Epub 2006 Nov 14.
About 20% of patients with colorectal cancer have synchronous un-resectable liver metastases. Resection of colorectal cancer in patients with moderate-severe symptoms is mandatory before starting chemotherapy. Surgical treatment of asymptomatic colorectal cancers is still a matter of discussion.
From January 2000 to December 2004, we prospectively collected data on 35 consecutive patients who were treated straightaway by chemotherapy without primary tumor resection. All patients underwent FOLFOX6 as first-line chemotherapy. The aim of the study was to evaluate the rate of surgical complications related to un-resected colorectal tumor.
The mean interval between diagnosis and start of chemotherapy was 23.1 days (95% CI: 17.3-28.8). Fifteen of the 35 patients (42.9%) were down-staged to surgery; the mean interval between chemotherapy start and colon-rectum cancer resection was 6.5 months (95% CI: 5.5-7.5). None of them developed complications related to the primary tumor during chemotherapy. Of the other 20 patients who did not undergo any curative surgery, 16 received a second line chemotherapy and 10 a third line: six patients are alive and without intestinal symptoms (mean follow up 22.5 months, 95% CI: 11.2-33.9). Only one patient (2.8%) developed clinical signs of intestinal occlusion 5.6 months from the start of chemotherapy and required urgent colostomy.
The rate of complications related to the non-resected colorectal tumor is very low using oxaliplatin as first line chemotherapy. Non-operative management of asymptomatic colorectal cancers with un-resectable liver metastases is a safe approach.
约20%的结直肠癌患者存在同时性不可切除肝转移。对于有中重度症状的结直肠癌患者，在开始化疗前必须切除肿瘤。无症状结直肠癌的手术治疗仍存在争议。
2000年1月至2004年12月，我们前瞻性收集了35例未经原发肿瘤切除直接接受化疗患者的数据。所有患者均接受FOLFOX6作为一线化疗。本研究的目的是评估与未切除的结直肠肿瘤相关的手术并发症发生率。
诊断至化疗开始的平均间隔时间为23.1天（95%可信区间：17.3 - 28.8）。35例患者中有15例（42.9%）降期至可手术切除；化疗开始至结直肠癌切除的平均间隔时间为6.5个月（95%可信区间：5.5 - 7.5）。他们在化疗期间均未发生与原发肿瘤相关的并发症。另外20例未接受任何根治性手术的患者中，16例接受了二线化疗，10例接受了三线化疗：6例患者存活且无肠道症状（平均随访22.5个月，95%可信区间：11.2 - 33.9）。仅1例患者（2.8%）在化疗开始5.6个月后出现肠梗阻临床症状，需要紧急行结肠造口术。
以奥沙利铂作为一线化疗，与未切除的结直肠肿瘤相关的并发症发生率非常低。对有不可切除肝转移的无症状结直肠癌进行非手术治疗是一种安全的方法。
