Abreu de Carvalho L F, Scuderi V, Maes H, Cupo P, Geerts B, Van Bockstal M, Gremonprez F, Willaert W, Pattyn P, Troisi R, Ceelen W
Department of General HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
Acta Chir Belg. 2015 Jul-Aug;115(4):261-7. doi: 10.1080/00015458.2015.11681109.
The outcome of stage IV colorectal cancer (CRC) has improved with modern systemic therapy. However, the concomitant presence of liver metastases (LM) and peritoneal carcinomatosis (PC) remains associated with a dismal prognosis and surgery in this context remains exceptional.
Stage IV CRC patients with LM and PC undergoing simultaneous cytoreductive surgery, intraperitoneal chemotherapy (IPC) and liver resection/ablation were identified from prospectively collected databases. We assessed response to neoadjuvant chemotherapy (NACT), postoperative complications, progression free survival (PFS), and overall survival (OS).
Twenty-one patients with resectable disease were treated between 2007 and 2014. In 16 patients (76%), NACT was administered and tumour response defined their selection. The remaining 5 (24%) were selected according to the pattern of recurrence. Median peritoneal cancer index was 5 (range: 3-10.5). Liver surgery included 34 wedge resections, 5 ablations and one bisectionectomy to treat a total of 45 hepatic lesions with a median of 2 per patient (range: 1-2) and a median size of 1.35 cm (range: 0.8-2). Tumour regression grade 4 (fibrosis but residual cancer cells predominate) was seen in 50% of the resected metastases after NACT. Median hospital stay was 17 days (range: 14-24); severe morbidity (Clavien-Dindo grade 3-4) occurred in 24% and no perioperative mortality (0-90 days) was recorded. The median OS was 44 months (range: 31-57) while the median PFS was 10 months (range: 8-12).
Combined parenchyma-preserving liver resection, cytoreductive surgery and IPC in patients with LM and PC from CRC can be performed safely and results in promising mid-term overall survival.
随着现代全身治疗方法的应用，IV期结直肠癌（CRC）的治疗效果有所改善。然而，肝转移（LM）和腹膜癌（PC）同时存在仍与预后不良相关，在此情况下手术治疗仍属例外。
从前瞻性收集的数据库中识别出接受同步细胞减灭术、腹腔内化疗（IPC）和肝切除/消融的IV期CRC伴LM和PC患者。我们评估了新辅助化疗（NACT）的反应、术后并发症、无进展生存期（PFS）和总生存期（OS）。
2007年至2014年间，对21例可切除疾病患者进行了治疗。16例患者（76%）接受了NACT治疗，并根据肿瘤反应来决定是否进行手术。其余5例（24%）根据复发模式进行选择。腹膜癌指数中位数为5（范围：3 - 10.5）。肝脏手术包括34例楔形切除术、5例消融术和1例半肝切除术，共治疗45个肝病灶，每位患者的病灶中位数为2个（范围：1 - 2），病灶大小中位数为1.35厘米（范围：0.8 - 2）。NACT后，50%的切除转移灶出现肿瘤退缩分级为4级（纤维化但仍以残留癌细胞为主）。中位住院时间为17天（范围：14 - 24天）；24%的患者出现严重并发症（Clavien - Dindo 3 - 4级），未记录围手术期死亡率（0 - 90天）。中位OS为44个月（范围：31 - 57个月），而中位PFS为10个月（范围：8 - 12个月）。
对于CRC伴LM和PC的患者，联合保留实质的肝切除术、细胞减灭术和IPC可以安全进行，并能带来有希望的中期总生存期。
