Resection of Concomitant Hepatic and Extrahepatic Metastases from Colorectal Cancer - A Worthwhile Operation?

Abstract

Introducere: Beneficiul rezecţiei hepatice în cazul metastazelor hepatice şi extrahepatice colorectale (MHEHCR) este încă discutabil. Scopul acestui studiu este de a evalua rezultatele rezecţiei metastazelor hepatice şi extrahepatice efectuate pacienţilor cu MHEHCR într-un centru medical cu un volum mare de intervenţii chirurgicale, atât în sfera chirurgiei hepato-biliare, cât şi în sfera chirurgiei colo-rectale şi de a identifica factorii de prognostic care se corelează cu o supravieţuire îndelungată. Metoda: Studiul este unul retrospectiv şi se bazează pe un lot de 678 de pacienţi consecutivi, cu metastaze hepatice ale cancerului colo-rectal operate într-un singur centru chirurgical, în perioada aprilie 1996 -martie 2016. Dintre aceştia, 73 de pacienţi au prezentat MHEHCR. Analiza univariată a fost efectuată pentru identificarea acelor factori de risc ce influenţează supravieţuirea generală (SG) . Rezultate: Au fost 20 de metastaze extrahepatice localizate la nivelul pediculului hepatic, 20 la nivel peritoneal, 12 la nivel ovarian şi pulmonar, 9 cu alte localizări şi 12 recidive locale. Au fost efectuate 53 de rezecţii curative (RO). Supravieţuirea Original ArticleChirurgia (2017) comparativă între lotul pacienţilor cu MHEHCR şi cel al pacienţilor cu metastaze strict hepatice a arătat o diferenţă semnificativă statistic în favoarea celui de-al doilea lot (p <0,0001), acelaşi rezultat fiind înregistrat şi în prezenţa rezecţiei R0 în cele două loturi (p <0,0001). În grupul MHEHCR, SG a fost semnificativă statistic mai mare la pacienţii care au beneficiat de rezecţie R0 faţă de cei la care rezecţia a fost R1/R2 (p = 0,004). Analiza univariată a identificat trei variabile drept factori de prognostic negativ pentru SG: 4 sau mai multe metastaze hepatice, efectuarea unei hepatectomii majore şi perioada realizării rezecţiei hepatice (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Localizarea ovariană sau pulmonară a metastazelor extrahepatice este corelată cu cea mai bună rată de supravieţuire dintre toate localizările posibile dar fară a fi semnificativă statistic. Concluzie: La pacienţii cu metastaze hepatice şi extrahepatice concomitente, rezecţia completă (R0) a acestora prelungeşte în mod semnificativ supravieţuirea. Pacienţii cu mai puţin de 4 metastaze hepatice, a căror rezecţie este realizată printr-o hepatectomie minoră sunt cei care beneficiază cel mai mult de pe urma acestei conduite terapeutice onco-chirurgicale agresive.Cuvinte cheie: metastaze hepatice ale cancerului colo-rectal, metastaze extrahepatice, metastaze hepatice şi extrahepatice ale cancerului colo-rectal, rezecţie hepatică, supravieţuire generală, factori de prognostic AbstractBackground: The benefit of hepatic resection in case of concomitant colorectal hepatic and extrahepatic metastases (CHEHMs) is still debatable. The purpose of this study is to assess the results of resection of hepatic and extrahepatic metastases in patients with CHEHMs in a high-volume center for both hepatobiliary and colorectal surgery and to identify progn...

Predictors of long‐term survival in patients with hepatic resection of colorectal metastases: Analysis of a Brazilian Cancer Center Cohort

“…Our study provides further evidence to support the idea that the most important variables associated with long‐term outcomes in patients who underwent metastatic colorectal cancer hepatectomy are those associated with the natural biology of the patients' disease (eg, extrahepatic and bilobar spread), rather than surgical procedures or patient‐related intrinsic factors. However, our results do not justify the exclusion of such patients from a multimodality treatment plan with inclusion of a surgical approach, as this subject is still controversial in previous published literature 22,23 …”

“…However, our results do not justify the exclusion of such patients from a multimodality treatment plan with inclusion of a surgical approach, as this subject is still controversial in previous published literature. 22,23 This study also has some limitations, largely related to its retrospective nature. Although surgical and systemic treatments of all patients were performed by the same group of surgeons and clinicians, differences in indications, as well as selection and availability of drugs occurred throughout the years of the study.…”

The prognosis of colorectal cancer liver metastases associated with inflammatory bowel disease: An exploratory analysis

“…Instead, nine patients with IBD‐related CRLM had an isolated intrahepatic recurrence, while the majority of extrahepatic recurrences involved the lungs (n = 7). In turn, given that isolated intrahepatic and extrahepatic pulmonary recurrences are amenable to re‐resection and have been associated with better outcomes than other recurrence sites, it may not be surprising that OS rates were ultimately similar in the two groups . This hypothesis is further supported by the fact that a larger percentage of patients (n = 10; 50%) with IBD‐related recurrence underwent surgical treatment with curative intent.…”

“…In turn, given that isolated intrahepatic and extrahepatic pulmonary recurrences are amenable to re-resection and have been associated with better outcomes than other recurrence sites, it may not be surprising that OS rates were ultimately similar in the two groups. [24][25][26][27][28][29][30] This Colorectal cancer development in patients with IBD has been shown to correlate with duration and extent of the disease. [31][32][33] As a result, dysplasia surveillance programs starting within 8 years after IBD diagnosis, are currently recommended across the world.…”

A Nomogram Model for Predicting Prognosis of Obstructive Colorectal Cancer

“…Diaconescu and his colleagues assessed the results of resection of hepatic and extrahepatic metastases in patients with hepatic and extrahepatic metastases, and demostrated that complete resection of metastatic burden signi cantly prolong survival [29]. For advanced oCRC patients, we could rstly consider using methods such as stoma or stent implantation to release the obstruction, give neoadjuvant or conversion therapy and seek radical resection.…”