Kakati Rasha T, Faraj Walid, Qaraqe Taha, El Chaer Frederic, Hussain Hero, Shamseddine Ali, Khalife Mohamad Jawad
Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
J Surg Case Rep. 2022 Aug 31;2022(8):rjac142. doi: 10.1093/jscr/rjac142. eCollection 2022 Aug.
Immunotherapy poses new considerations and alterations to the management of metastatic colorectal carcinoma (mCRC), where chemotherapy achieves complete radiological response but yields complete pathological response in few patients only. Immunotherapy may be superior in the conversion of unresectable disease to resectable liver lesions from mCRC and downsizing borderline lesions for more feasible resectability and achieving complete pathologic response, with the potential for cure and to alter current, established guidelines for surgical resection with a shift from chemotherapy. We present two patients with hepatic lesions from mCRC characterized by deficient mismatch repair (dMMR) which were unresectable after traditional chemotherapy but were converted to resectable lesions with a complete histopathological response following immunotherapy. Complete histopathologic response and radiologic regression or disappearance of liver lesions was observed in patients with dMMR mCRC after pembrolizumab. Immunotherapy exhibits notable potential for cure, achieving complete, successful surgical resection and improving prognosis.
免疫疗法为转移性结直肠癌（mCRC）的治疗带来了新的考量和改变，在mCRC中，化疗虽能实现完全的影像学缓解，但仅有少数患者能获得完全的病理缓解。免疫疗法在将mCRC不可切除的病灶转化为可切除的肝转移灶、缩小临界病灶以提高可切除性并实现完全病理缓解方面可能更具优势，具有治愈潜力，并可能改变当前既定的手术切除指南，从化疗转向免疫疗法。我们报告了2例mCRC肝转移患者，其特征为错配修复缺陷（dMMR），传统化疗后不可切除，但经免疫疗法后转化为可切除病灶，并获得了完全的组织病理学缓解。帕博利珠单抗治疗后，dMMR mCRC患者出现了肝转移灶的完全组织病理学缓解以及影像学消退或消失。免疫疗法具有显著的治愈潜力，可实现完全、成功的手术切除并改善预后。
