Lygidakis N J, Bhagat Anand D, Vrachnos P, Grigorakos L
Department of Surgical Oncology, Medical Centre Psychiko, KAT Hospital, Athens, Greece.
Hepatogastroenterology. 2007 Jun;54(76):1020-4.
BACKGROUND/AIMS: This study was designed to assess the efficacy of two-stage liver surgery and hepatic directed chemo-biological therapy in treatment of synchronous bilobar hepatic metastases of colorectal origin.
A total of thirty-two patients were included in this study that were diagnosed to have colorectal carcinoma with synchronous bilobar hepatic metastases. During stage one surgery along with excision of primary colorectal carcinoma; ligation and transection of main portal branch on side of bulky metastases disease (right branch in 28 and left in 4 patients) was performed. The metastatic nodules in the opposite lobe were ablated by microwave therapy and a hepatic arterial jet port catheter was introduced via the gastroduodenal artery for liver directed chemo-biological therapy. The catheter was connected to a subcutaneously placed port. Three cycles of chemotherapeutic drugs and Avastin (Bevacizumab) were given via hepatic arterial infusion (HAI) at intervals of twenty-five days. During the second stage surgery hepatic resection was carried out followed by continuation of hepatic arterial infusion of chemobiological drugs as adjuvant therapy.
In the follow-up period of 31 months, 1-year survival of 100% and 2-year survival of 80% with a mean 28 months survival was noted.
Combined approach of ligating the portal branch, microwave ablation, hepatic regional chemo-biological therapy and staged liver surgery (a multimodality approach) in the treatment of advanced liver metastatic disease synchronous with colorectal cancer is an effective method of treatment which improves the overall survival and quality of life of the patient with hepatic bilobar metastases synchronous with colorectal carcinoma. Avastin, a monoclonal antibody against vascular endothelial growth factor; used for inhibition of tumor growth has shown its efficacy in early results and holds good promise for the future.
背景/目的：本研究旨在评估两阶段肝手术及肝靶向化学生物治疗在治疗结直肠癌同步双叶肝转移中的疗效。
本研究共纳入32例被诊断为患有结直肠癌并伴有同步双叶肝转移的患者。在第一阶段手术中，除了切除原发性结直肠癌外，还对转移瘤较大一侧的主要门静脉分支进行结扎和横断（28例为右分支，4例为左分支）。对另一侧叶的转移结节进行微波消融，并通过胃十二指肠动脉插入肝动脉喷射端口导管进行肝靶向化学生物治疗。该导管连接到皮下植入的端口。通过肝动脉灌注（HAI）每隔25天给予三个周期的化疗药物和阿瓦斯汀（贝伐单抗）。在第二阶段手术中进行肝切除，随后继续进行肝动脉灌注化学生物药物作为辅助治疗。
在31个月的随访期内，观察到1年生存率为100%，2年生存率为80%，平均生存时间为28个月。
结扎门静脉分支、微波消融、肝区域化学生物治疗和分期肝手术相结合的方法（一种多模式方法）在治疗与结直肠癌同步的晚期肝转移疾病中是一种有效的治疗方法，可提高患有与结直肠癌同步双叶肝转移患者的总体生存率和生活质量。阿瓦斯汀，一种抗血管内皮生长因子的单克隆抗体，用于抑制肿瘤生长，已在早期结果中显示出其疗效，并对未来充满希望。
