Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Campus Box 8109, St. Louis, MO, 63110, USA.
World J Surg. 2010 May;34(5):1102-8. doi: 10.1007/s00268-010-0483-7.
Resection of primary and liver lesions is the optimal management of Stage IV rectal cancer with liver metastases. For patients with extensive liver metastases, FOLFOX and FOLFIRI have improved resection rates and survival. We compared survival outcomes in patients with Stage IV rectal cancer with liver metastases undergoing staged or synchronous resection with those undergoing primary rectal resection only or no resection at all.
Patients with metastatic rectal cancer to liver were identified from a colorectal cancer database from 2002 to 2008. Patients received neoadjuvant chemoradiation and adjuvant FOLFOX or FOLFIRI therapy. The outcomes for patients who underwent synchronous resection, staged resection, resection of rectal tumor only, and no resection with chemotherapy only were compared. Statistical analysis was determined by ANOVA. Survival was determined using the Kaplan-Meier method.
Seventy-four patients were identified: 30 synchronous resections, 13 staged resections, 22 primary resection only, and 9 no resection. Median follow-up was 23 months (range = 4-58 months). Sixty-five percent of patients underwent liver resection with 26% rendered eligible for resection after adjuvant therapy. Those who underwent primary resection only had shorter median survival than those who underwent either staged or synchronous liver resection (31 vs. 47 vs. 46 months, respectively; P = 0.17). Survival was no different for synchronous versus staged resection (P = 0.6). Volume of liver disease predicted resectability (P = 0.001). Without liver resection, 2-year survival was approximately 60%. Palliative surgery was required in six of nine patients who did not undergo resection of their primary tumor.
Current chemotherapeutic regimens lead to improved survival in patients with unresectable liver metastases. Upfront chemotherapy in the asymptomatic patient compared with resection of the primary tumor does not appear to significantly affect survival. However, given that 60% of patients were alive after 2 years, resection of the primary lesion for palliative reasons and local control must be considered.
对于伴有肝转移的 IV 期直肠癌患者，原发灶和肝脏病灶的切除术是最佳治疗方案。对于广泛肝转移的患者，FOLFOX 和 FOLFIRI 方案可提高切除率和生存率。我们比较了接受分期或同步切除、仅接受原发灶直肠切除术或未行切除术患者的 IV 期直肠癌伴肝转移患者的生存结局。
从 2002 年至 2008 年的结直肠癌数据库中确定转移性直肠癌肝转移患者。所有患者均接受新辅助放化疗及辅助 FOLFOX 或 FOLFIRI 治疗。比较同步切除、分期切除、仅切除直肠肿瘤和仅化疗而未切除的患者的结局。采用方差分析进行统计学分析。采用 Kaplan-Meier 方法确定生存情况。
共确定 74 例患者：30 例同步切除，13 例分期切除，22 例仅行原发灶直肠切除术，9 例未行切除术。中位随访时间为 23 个月（范围=4-58 个月）。65%的患者行肝脏切除术，其中 26%的患者经辅助治疗后可获得切除机会。仅行原发灶直肠切除术患者的中位生存期短于行分期或同步肝切除术的患者（分别为 31 个月、47 个月和 46 个月，P=0.17）。同步与分期切除患者的生存情况无差异（P=0.6）。肝脏疾病的体积预测了可切除性（P=0.001）。未行肝脏切除术患者的 2 年生存率约为 60%。9 例未行原发灶切除术的患者中有 6 例需要行姑息性手术。
目前的化疗方案可提高不可切除肝转移患者的生存率。与切除原发灶相比，无症状患者行初始化疗似乎并不会显著影响生存情况。但是，鉴于 2 年后有 60%的患者仍存活，出于姑息治疗和局部控制的目的，仍应考虑切除原发灶。
