Fuks D, Cook M-C, Bréhant O, Henegar A, Dumont F, Chatelain D, Yzet T, Mulieri G, Joly J-P, Nguyen-Khac E, Dupas J-L, Mauvais F, Verhaeghe P, Regimbeau J-M
Service de Chirurgie Digestive et Viscérale, CHU d'Amiens-Nord, Place Victor-Pauchet, 80054 Amiens Cedex 1, France.
Gastroenterol Clin Biol. 2008 Apr;32(4):390-400. doi: 10.1016/j.gcb.2008.01.034. Epub 2008 Apr 10.
The management of patients with colorectal cancer (CRC) and synchronous liver metastases (SLM) depends on the primitive tumor, resectability of the metastatic disseminations and the patient's comorbid condition(s). Considering all patients with potentially resectable primary CRC and SLM, curative resection (R0) will be possible in some patients, although in others surgery will never be performed. The purpose of our study was to identify factors of failure of the curative schedule in these patients.
We reviewed the data of patients with CRC and SLM between January 2002 and March 2007. Two groups were defined: group R0 when complete metastatic and primary tumor resection was finally achieved after one and more surgical stages and group R2 when curative resection was not possible at the end of the schedule. Clinical, pathologic and outcome data were retrospectively analyzed as well as preoperative management of SLM (chemotherapy, radiofrequency, portal vein embolization).
Forty-five patients were included. Curative resection (group R0) was performed in 31 patients (69%) with 48% undergoing major hepatic resection. Mortality of hepatic resection was 0% although it was 9% for primitive tumor. Portal vein embolization was performed preoperatively in eight patients and radiofrequency ablation in 13. Median follow-up was 21 months. Overall survival was 86% at one year and 39% at three years. Survival in group 1 was 97 and 57% at one and three years respectively. Disease-free survival was 87 and 40% at one and three years. Tumor recurrence was noted in 61% of resected patients. At multivariate analysis, number of hepatic metastases superior than three and complicated initial presentation of primitive tumor were found to be significant and predictors of failure of hepatic resection.
Aggressive management with curative resection of SLM may enable long-term survival. More than three SLM and complicated initial presentation of primitive tumor are factors predictive of failure of the curative schedule.
结直肠癌（CRC）合并同时性肝转移（SLM）患者的治疗取决于原发肿瘤情况、转移灶的可切除性以及患者的合并症。对于所有潜在可切除的原发性CRC和SLM患者，部分患者有可能实现根治性切除（R0），但其他患者可能永远无法进行手术。我们研究的目的是确定这些患者根治性治疗方案失败的因素。
我们回顾了2002年1月至2007年3月期间CRC合并SLM患者的数据。定义了两组：R0组为经过一个或多个手术阶段最终实现了转移性和原发性肿瘤的完全切除；R2组为在治疗方案结束时无法进行根治性切除。对临床、病理和结局数据以及SLM的术前处理（化疗、射频、门静脉栓塞）进行了回顾性分析。
纳入了45例患者。31例患者（69%）进行了根治性切除（R0组），其中48%接受了肝大部切除术。肝切除的死亡率为0%，而原发性肿瘤切除的死亡率为9%。8例患者术前进行了门静脉栓塞，13例进行了射频消融。中位随访时间为21个月。1年总生存率为86%，3年为39%。第1组1年和3年生存率分别为97%和57%。无病生存率1年和3年分别为87%和40%。61%的切除患者出现肿瘤复发。多因素分析发现，肝转移灶数量超过3个以及原发性肿瘤初始表现复杂是肝切除失败的显著预测因素。
积极进行SLM的根治性切除治疗可能实现长期生存。超过3个SLM以及原发性肿瘤初始表现复杂是根治性治疗方案失败的预测因素。
