Li Destri Giovanni, Puzzo Lidia, Russo Alessia Erika, Ferraù Francesco, Di Cataldo Antonio, Puleo Stefano
University of Catania, Department of "Medical and Surgical Sciences and Advanced Technology G.F. Ingrassia"- Via Santa Sofia 86, 95123 Catania Italy.
St. Vincent Hospital, Division of Medical Oncology, Contrada Sirina, 98039 Taormina, Messina, Italy.
Int J Surg Case Rep. 2017;30:138-141. doi: 10.1016/j.ijscr.2016.11.044. Epub 2016 Nov 23.
In the international literature we have never found a long survival in patients treated for a colon cancer with synchronous hepatic metastases and for a metachronous Krukenberg tumor.
A 46-year old woman for an advanced colon cancer with a synchronous hepatic metastases was subjected to a left hemicolectomy and a resection of liver segment V (R0 resection; T4N2bM1; stage IVa according AJCC 2010). After one year a CT of the abdomen revealed an expansive formation of the left ovary. The patient was subjected to a bilateral ovariectomy, hysterectomy and hiperthermic intraperitoneal chemotherapy (HIPEC). The patient, after several cycles of adjuvant chemotherapy, is disease-free 13 years after surgery.
To our knowledge, in the literature there do not appear to be cases of such disease-free survival. The survival of patient despite the prognostic indexes is discussed. The authors discus the importance of an adequate surgical treatment especially for liver metastases simultaneously treated to colon cancer. The authors also focus on chemotherapy (FOLFOX and then FOLFIRI) performed in a pre-biological era. Furthermore, the degree to which the HIPEC may have had an impact is still unknown, although it seems to be the gold standard for the treatment of the microscopic peritoneal neoplastic remnant.
The authors emphasize that the long term survival in colon cancer with hepatic and ovarian metastases is possible as long as it has an adequate surgical approach, a tailored chemotherapy and an intensive follow-up. Most likely new prognostic markers will have to be identified.
在国际文献中，我们从未发现患有同步肝转移的结肠癌和异时性库肯伯格瘤的患者能长期存活。
一名46岁女性因患有伴有同步肝转移的晚期结肠癌接受了左半结肠切除术和肝V段切除术（R0切除；T4N2bM1；根据2010年美国癌症联合委员会分期为IVa期）。一年后，腹部CT显示左卵巢有一个增大的肿物。该患者接受了双侧卵巢切除术、子宫切除术和热灌注腹腔化疗（HIPEC）。在经过几个周期的辅助化疗后，患者术后13年无疾病。
据我们所知，文献中似乎没有这种无病生存的病例。讨论了尽管有预后指标但患者仍存活的情况。作者讨论了充分的手术治疗尤其是对与结肠癌同时治疗的肝转移的重要性。作者还关注了在生物治疗时代之前进行的化疗（FOLFOX然后FOLFIRI）。此外，HIPEC可能产生的影响程度仍然未知，尽管它似乎是治疗微小腹膜肿瘤残余的金标准。
作者强调，只要有适当的手术方法、量身定制的化疗和密集的随访，患有肝转移和卵巢转移的结肠癌患者有可能长期存活。很可能必须识别出新的预后标志物。
