Hepatectomia para o tratamento de metástases colorretais e não-colorretais: análise comparativa em 30 casos operados

Costa, Sergio Renato Pais; Horta, Sérgio Henrique Couto; Henriques, Alexandre Cruz; Waisberg, Jaques; Speranzini, Manlio Basílio

doi:10.1590/s0101-98802009000200009

Cited by 4 publications

(6 citation statements)

References 29 publications

(41 reference statements)

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“…the results, when the nCR metastases resection is performed in selected cases, are similar to those observed in CR metastases resection, with rates in a 5-year survival ranging from 20 up to 45% [8][9][10][11][12][13] . in our community, the author of this study, in a prior study that compared CR and nCR metastases, observed similar survival, of around 20%, in a 5-year survival for the two groups 7 . Literature shows that this practice has been more freely adopted, especially when the disease remains exclusively confined to the liver, limited to one lobe, and mainly when the disease-free survival (dFs) between the primary tumor treatment and the distant lesion presentation is more than two years [8][9][10][11][12][13] .…”

Section: Introductionsupporting

confidence: 61%

“…However, the proper selection seems to be the main rationale of resection. then, factors such as: patient's good conditions in general; proper nutritional and hepatic reserves; exclusively hepatic lesion; long disease-free survival between the primary tumor treatment and the presentation of metastases; and the nCR metastases etiology itself, seem to be the most important prognostic criteria for long-time survival observed in the literature [7][8][9][10][11][12][13] .…”

Section: Discussionmentioning

confidence: 99%

“…then, the deeper knowledge of anatomy and surgery technique, combined with the increasingly improved support conditions, both in the intraoperative and postoperative periods, has lead to substantially reduced mortality in this operation 1 . in parallel, due to developments in hepatic surgery, hepatectomy has been freely indicated for the treatment of CR metastases, where resection is the only way of healing or extended survival [1][2][3][4][5][6][7] . More recently, several series in the literature have also demonstrated satisfactory results in the resection of non-colorectal (nCR) metastases.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic left lateral segmentectomy for metachronic metastases of small intestine adenocarcinoma: a case report

Pais-Costa¹,

Araujo

Lima³

et al. 2011

J. Coloproctol. (Rio J.)

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Hepatectomy has been the standard treatment for metachronic metastases of non-colorectal (NCR) origin, mainly when the disease-free interval is more than two years. Laparoscopic hepatectomy has become the golden standard mainly for left side resections, due to lower morbidity, shorter hospital stay, early recovery and good cosmetic outcome. The authors report the case of a female patient with two metachronic metastases (ten years of disease-free survival), of non-colorectal origin (adenocarcinoma of small intestine), treated by laparoscopic left lateral segmentectomy (left hepatic lobectomy) with success. The postoperative progress was satisfactory. To date, the patient has presented no tumoral recurrence (six months of follow-up period). Laparoscopic left lateral segmentectomy can be satisfactorily performed in selected cases of hepatic metastasis. This approach presents low morbidity and good cosmetic result. The lack of alternative treatments and the poor prognosis of untreated cases have justified surgical resection in order to increase overall survival. Nevertheless, this approach should be performed by hepatic surgery expertise teams trained on advanced laparoscopic procedures.
A hepatectomia tem sido o tratamento padrão para metástase de origem não colorretal (NCR) metacrônica, principalmente quando o intervalo livre de doença é maior do que dois anos. A hepatectomia por laparoscopia tem se tornado padrão principalmente para as ressecções à esquerda, haja vista a menor morbidade, menor tempo de internação, reabilitação precoce e melhor resultado estético. Os autores relatam um caso de paciente com duas metástases metacrônicas (10 anos de sobrevida livre de doença), de etiologia não colorretal (adenocarcinoma de intestino delgado), tratada com segmentectomia lateral esquerda (lobectomia hepática esquerda) laparoscópica. Paciente apresentou boa evolução pós-operatória sem recidiva (seis meses de seguimento). Segmentectomia lateral esquerda laparoscópica pode ser satisfatoriamente realizada em casos selecionados de metástases hepáticas, acarretando menor morbidade e melhor resultado estético. A falta de tratamentos alternativos e o prognóstico reservado nos casos de metástases NCR não operadas justificam a ressecção com o objetivo de prolongar a sobrevida. No entanto, essa abordagem deve ser realizada por equipe especializada em cirurgia hepática com treinamento em procedimentos laparoscópicos avançados

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Section: Introductionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laparoscopic left lateral segmentectomy for metachronic metastases of small intestine adenocarcinoma: a case report

Pais-Costa¹,

Araujo

Lima³

et al. 2011

J. Coloproctol. (Rio J.)

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“…Chemotherapy has become better developed, with new drugs, particularly for treating metastases, thus promoting better responses and enabling indications for surgical treatment among patients who earlier would not have been candidates for resection 4 , 16 . A recent study showed that in some situations the results from hepatectomy to treat colorectal and non-colorectal metastases were similar 6 , thus further expanding the group of patients who are candidates for hepatectomy. Three and a half years ago, the authors began a prospective study with this objective, initially evaluating the associated morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Hepatectomy: a critical analysis on expansion of the indications

Lopes-Junior

Belebecha

Jacob

2014

ABCD, arq. bras. cir. dig.

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BackgroundHepatic resection has evolved to become safer, thereby making it possible to expand the indications.AimTo assess the results from a group of patients presenting these expanded indications.MethodWere prospectively studied all the hepatectomy procedures performed for hepatic tumor resection. Patients with benign and malignant primary and secondary tumors were included. Were included variables such as age, gender, preoperative diagnosis, preoperative treatment, type of operation performed, need for transfusion, final anatomopathological examination and postoperative evolution. The patients were divided into two groups: group A, with a traditional indication for hepatectomy; and group B, with an expanded indication (tumors in both hepatic lobes, extensive resection encompassing five or more segments, cirrhotic livers and postoperative chemotherapy using hepatotoxic drugs).ResultsWere operated 38 patients, and 40 hepatectomies were performed: 28 patients in group A and 10 in group B. The mean age was 57.7 years, and 25 patients were women. Three in group B were operated as two separate procedures. Groups A and B received means of 1.46 and 5.5 packed red blood cell units per operation, respectively. There were three cases with complications in group A (10.7%) and six in group B (60%). The mortality rate in group A was 3.5% (one patient) and in groups B, 40% (four patients). The imaging examinations were sensitive for the presence of tumors but not for defining the type of tumor. The blood and derivative transfusion rates, morbidity and mortality were greater in the group with expanded indications and more extensive surgery.ConclusionThe indications for liver biopsy and portal vein embolization or ligature can be expanded, with special need of cooperation of the anesthesiology department and the use of hepatic resection devices to diminish blood transfusion.

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“…O número e tamanho das metástases assim como o intervalo de livre de doença entre o tumor primário e a lesão metastática, a taxa sérica do antígeno carcinoembrionario bem como as margens cirúrgicas tem sido apontadas como importantes fatores de sobrevida em longo prazo. Devido aos avanços na cirurgia hepática tem havido uma maior liberdade nas indicações das hepatectomias para o tratamento das metástases, mormente nas de etiologia colorretal (1)(2)(3)(4)(5)(6)(7). Embora no passado a invasão vascular tenha sido considerada critério absoluto de irressecabilidade, com a propagação das técnicas de transplante e maior experiência em hepatectomias tecnicamente mais complexas, atualmente a invasão de vasos vitais como a veia cava não tem sido obstáculo para a ressecção de metástases CR em casos ultraselecionados (8,9).…”

Section: Introductionunclassified

Hepatectomia direita ampliada com ressecção parcial da veia cava para metástase colorretal: relato de caso

Costa

Lima

Cunha³

et al. 2010

Rev bras. colo-proctol.

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RESUMO: Introdução: A hepatectomia tem sido o tratamento padrão para metástase de origem colorretal (CR). Metástase com invasão da veia cava inferior (VCI) pode requerer INTRODUÇÃOA hepatectomia tem sido considerada o tratamento curativo de escolha para as metástases de etiologia colorretal. Em revisão sistemática recentemente publicada, a taxa de sobrevida em cinco anos em 16 series incluindo somente ressecções R0 variou de 15 a 67 % com mediana de 30 %. Paralelamente, com o maior conhecimento anatômico e da técnica operatória aliada a crescente melhoria nas condições de suporte tanto no intra quanto no pós-operatório tem levado a uma diminuição substancial da mortalidade dessa operação. Neste mesmo estudo, a mortalidade pós-operatória variou de 0 a 6,6 % com mediana de 3 % (1).Diversos fatores prognósticos têm sido estudados em relação às metástases CR. O número e tamanho das metástases assim como o intervalo de livre de doença entre o tumor primário e a lesão metastática, a taxa sérica do antígeno carcinoembrionario bem como as margens cirúrgicas tem sido apontadas como importantes fatores de sobrevida em longo prazo. Devido

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Hepatectomia para o tratamento de metástases colorretais e não-colorretais: análise comparativa em 30 casos operados

Cited by 4 publications

References 29 publications

Laparoscopic left lateral segmentectomy for metachronic metastases of small intestine adenocarcinoma: a case report

Laparoscopic left lateral segmentectomy for metachronic metastases of small intestine adenocarcinoma: a case report

Hepatectomy: a critical analysis on expansion of the indications

Hepatectomia direita ampliada com ressecção parcial da veia cava para metástase colorretal: relato de caso

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