Results of Individualized Treatment of Colorectal Cancer with Liver Metastasis
Öz
Aim: Liver metastasis is the most common cause of death in colorectal cancer (CRC). In cases of recurrent liver metastasis, individualized aggressive local treatments are recommended for better survival outcomes. In this study, we aimed to present the health outcomes obtained in a group of highly selected patients with metastatic CRC.
Materials and Methods: Medical records of a total of 45 (28 males, 17 females) patients who were diagnosed with CRC with liver metastasis and underwent surgical treatment between March 2013 and November 2018 were reviewed retrospectively.
Results: The median patient age was 61 years. Thirty-two patients were diagnosed with synchronous metastasis, of whom 21 underwent synchronous surgery. The median time for metachronous metastasis development was 18 months. Twenty-three patients developed bilobar metastasis, with a median number of 4 (1–18) metastases. Eleven (10 synchronous and 1 metachronous metastasis) patients underwent liver resection without perioperative chemotherapy while the other 34 received perioperative treatment. While parenchyma-preserving liver surgery (metastasectomy/segmentectomy) as performed in 34 patients was the most common surgical approach, surgery in 10 patients (for 31 metastasis) was combined with ablation, again in accordance with the oncological principles. The median tumor size and surgical margin were 35 mm and 3 mm, respectively. Surgical margin was positive in 4 patients, of whom only 1 developed local recurrences. In a median time of 12 months, a total of 20 patients developed recurrent liver metastasis, and 12 of them underwent surgery again. The median survival was 32 months for all 45 patients and 36 months for the 12 patients who underwent secondary surgery due to recurrence.
Discussion and Conclusion: Aggressive, individualized, multidisciplinary treatments could provide better long-term survival outcomes in CRC with liver metastasis. Synchronous or staged interventions are applicable with acceptable morbidity and mortality rates. In cases of recurrent metastasis, parenchyma-preserving procedures should be preferred for increased chances of repeated surgical treatment.
Anahtar Kelimeler
hepatectomy,liver resection,metastasectomy,microwave ablation
Kaynakça
- Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, Forman D, Bray F. Cancer incidence and mortality patterns in Europe: estimated for 40 countries in 2012. Eur J Cancer 2013 Apr;49(6):1374-403. doi: 10.1016/j.ejca.2012.12.027
- Brown RE, Bower MR, Martin RC. Hepatic resection for colorectal liver metastases. Surg Clin North Am. 2010 Aug;90(4):839-52. doi: 10.1016/j.suc.2010.04.012
- Fong Y, Cohen AM, Fortner JG, Enker WE, Turnbull AD, Coit DG, Marrero AM, Prasad M, Blumgart LH, Brennan MF. Liver resection for colorectal metastases. J Clin Oncol. 1997 Mar;15(3):938-46
- Rees M, Tekkis PP, Welsh FK, O'Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008 Jan;247(1):125-35
- Alvarez FA, Sanchez Claria R, Oggero S, de Santibañes E. Parenchymal-sparing liver surgery in patients with colorectal carcinoma liver metastases. World J Gastrointest Surg. 2016 Jun 27; 8(6):407-23
- Moris D, Dimitroulis D, Vernadakis S, Papalampros A, Spartalis E, Petrou A, Pawlik TM, Felekouras E. Parenchymal-sparing Hepatectomy as the New Doctrine in the Treatment of Liver-metastatic Colorectal Disease: Beyond Oncological Outcomes. Anticancer Res. 2017 Jan; 37(1):9-14
- Torzilli G, Viganò L, Cimino M, Imai K, Vibert E, Donadon M, Mansour D, Castaing D, Adam R. Is Enhanced One-Stage Hepatectomy a Safe and Feasible Alternative to the Two-Stage Hepatectomy in the Setting of Multiple Bilobar Colorectal Liver Metastases? A Comparative Analysis between Two Pioneering Centers. Dig Surg. 2018; 35(4):323-332
- Gold JS, Are C, Kornprat P, Jarnagin WR, Gönen M, Fong Y, DeMatteo RP, Blumgart LH, D'Angelica M. Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg. 2008 Jan;247(1):109-17
- Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L, Barbas AS, Abdalla EK, Choti MA, Vauthey JN, et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol. 2007;14:3481–91
- Hillingsø JG, Wille-Jørgensen P. Staged or simultaneous resection of synchronous liver metastases from colorectal cancer--a systematic review. Colorectal Dis. 2009 Jan;11(1):3-10. doi: 10.1111/j.1463-1318.2008.01625.