Department of Digestive Surgery Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France.
Department of Radiology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France.
BJS Open. 2019 Feb 22;3(3):344-353. doi: 10.1002/bjs5.50140. eCollection 2019 Jun.
Hepatic surgery is appropriate for selected patients with colorectal liver metastases (CRLM). Advances in chemotherapy have led to modification of management, particularly when metastases disappear. Treatment should address all initial CRLM sites based on pretherapeutic cross-sectional imaging. This study aimed to evaluate pretherapeutic fiducial marker placement to optimize CRLM treatment.
This pilot investigation included patients with CRLM who were considered for potentially curative treatment between 2009 and 2016. According to a multidisciplinary team decision, lesions smaller than 25 mm in diameter that were more than 10 mm deep in the hepatic parenchyma and located outside the field of a planned resection were marked. Complication rates and clinicopathological data were analysed.
Some 76 metastases were marked in 43 patients among 217 patients with CRLM treated with curative intent. Of these, 23 marked CRLM (30 per cent), with a mean(s.d.) size of 11·0(3·4) mm, disappeared with preoperative chemotherapy. There were four complications associated with marking: two intrahepatic haematomas, one fiducial migration and one misplacement. After a median follow-up of 47·7 (range 18·1-144·9) months, no needle-track seeding was noted. Of four disappearing CRLM that were marked and resected, two presented with persistent active disease. Other missing lesions were treated with thermoablation.
Pretherapeutic fiducial marker placement appears useful for the curative management of CRLM.
肝切除术适用于特定的结直肠癌肝转移（CRLM）患者。化疗的进步导致了治疗方法的改变，尤其是当转移灶消失时。应根据治疗前的横截面成像对所有初始 CRLM 部位进行治疗。本研究旨在评估治疗前基准标记物的放置情况，以优化 CRLM 的治疗效果。
本研究纳入了 2009 年至 2016 年间接受潜在根治性治疗的 CRLM 患者。根据多学科团队的决定，对直径小于 25mm、肝实质内深度超过 10mm 且位于计划切除范围之外的病变进行标记。分析了并发症发生率和临床病理数据。
在 217 例接受根治性治疗的 CRLM 患者中，有 43 例患者的 76 个转移灶被标记。其中，23 个标记的 CRLM（30%），平均（s.d.）直径为 11.0（3.4）mm，术前化疗后消失。标记相关的并发症有 4 例：2 例肝内血肿，1 例基准标记物迁移，1 例位置错误。中位随访时间为 47.7 个月（范围 18.1-144.9），未发现针道种植。4 个消失的标记并切除的 CRLM 中有 2 个仍存在持续性活跃性疾病。其他遗漏的病变则接受了热消融治疗。
治疗前基准标记物的放置对于 CRLM 的根治性治疗似乎是有用的。
