Tivadar Beatrice Mihaela, Dumitrascu Traian, Vasilescu Catalin
Department of General Surgery, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Fundeni Street No. 258, 022328 Bucharest, Romania.
J Clin Med. 2024 Apr 18;13(8):2362. doi: 10.3390/jcm13082362.
: Many papers exploring the role of resectioning metastases in colorectal cancer (CRC) have focused mainly on liver and lung sites, showing improved survival compared with non-resectional therapies. However, data about exceptional metastatic sites such as splenic metastases (SMs) are scarce. This paper aims to assess the role and effectiveness of splenectomy in the case of isolated metachronous SM of CRC origin. : The patients' data were extracted after a comprehensive literature search through public databases for articles reporting patients with splenectomies for isolated metachronous SM of CRC origin. Potential predictors of survival were explored, along with demographic, diagnostic, pathology, and treatment data for each patient. : A total of 83 patients with splenectomies for isolated metachronous SM of CRC origin were identified. The primary CRC was at an advanced stage (Duke's C-70.3%) and on the left colon (45.5%) for most patients, while the median interval between CRC resection and SM was 24 months. The median overall survival after splenectomy was 84 months, and patients younger than 62 years presented statistically significantly worse overall survival rates than those ≥62 years old ( = 0.011). There was no significant impact on the long-term outcomes for factors including primary tumor location or adjuvant chemotherapy ( values ≥ 0.070, ns). Laparoscopic splenectomy was increasingly used in the last 20 years from 2002 (33.3% vs. 0%, < 0.001). : Splenectomy is the optimal treatment for patients with isolated metachronous SM of CRC, with the laparoscopic approach being increasingly used and having the potential to become a standard of care. Encouraging long-term survival rates were reported in the context of a multidisciplinary approach. Younger ages are associated with worse survival. Perioperative chemotherapy in the context of a patient diagnosed with SM of CRC origin appears to be a reasonable option, although the present study failed to show any significant impact on long-term survival.
许多探讨结直肠癌(CRC)转移灶再切除作用的论文主要聚焦于肝脏和肺部转移,与非切除治疗相比,显示出生存改善。然而,关于脾转移(SMs)等特殊转移部位的数据却很稀少。本文旨在评估在孤立性异时性CRC源性SM情况下脾切除术的作用和有效性。 通过公共数据库进行全面文献检索,提取报告因孤立性异时性CRC源性SM而接受脾切除术患者的文章中的患者数据。探索生存的潜在预测因素,以及每位患者的人口统计学、诊断、病理学和治疗数据。 共确定了83例因孤立性异时性CRC源性SM而接受脾切除术的患者。大多数患者的原发性CRC处于晚期(杜克C期-70.3%)且位于左半结肠(45.5%),而CRC切除与SM之间的中位间隔为24个月。脾切除术后的中位总生存期为84个月,年龄小于62岁的患者总体生存率在统计学上显著低于年龄≥62岁的患者(P = 0.011)。包括原发性肿瘤位置或辅助化疗等因素对长期结局无显著影响(P值≥0.070,无统计学意义)。从2002年起的过去20年中,腹腔镜脾切除术的使用越来越多(33.3%对0%,P < 0.001)。 脾切除术是孤立性异时性CRC源性SM患者的最佳治疗方法,腹腔镜手术的使用越来越多,并有潜力成为一种标准治疗方式。在多学科治疗的背景下报告了令人鼓舞的长期生存率。年轻与较差的生存率相关。对于诊断为CRC源性SM的患者,围手术期化疗似乎是一个合理的选择,尽管本研究未能显示对长期生存有任何显著影响。
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