Kolorektal kanserlerin senkron karaciğer metastazları: Kombine cerrahi prosedür deneyimimiz

Öz

Amaç: Kolorektal kanserlerin (KRK) en sık metastaz yaptığı organ karaciğerdir ve tanı anında hastaların yaklaşık %25’inde senkron karaciğer metastazı bulunur. Karaciğer metastazı olan KRK hastalarında cerrahi yaklaşım hala tartışma konusudur. Her hasta için tedavi stratejisi, hastanın performans durumuna, komorbiditelerine ve tümör aşamasına bağlı olarak kişiselleştirilmelidir. Bu çalışmanın amacı kliniğimizde senkron karaciğer metastazlı KRK hastalarına yönelik tedavi yaklaşımımızı ortaya koymak ve literatürle karşılaştırmaktır.

Gereç ve Yöntemler: Ocak 2016 ile Aralık 2018 yılları arasında senkron karaciğer metastazlı KRK tanılı, kombine cerrahi prosedür olarak adlandırılan eş seanslı kolorektal kanser ameliyatı ve hepatik rezeksiyon yapıldığı sekiz hasta çalışmaya dahil edildi.

Bulgular: İki hastaya sağ hepatektomi yapılırken, altı hastaya metastezektomi yapıldı. TNM evresine göre bir hastada (%12) T1/2, yedi hastada (%88) T3/4 tümör saptandı. Hastaların dördünde (%50) lenf nodu metastazı saptandı. Bir hasta post operatif  3. günde MODS nedeniyle kaybedildi.

Sonuç: Bizim çalışmamızın sonuçlarında da olduğu gibi literatürde senkronize yaklaşım için hasta seçiminde en önemli kriterler; hasta yaşı ve yapılan hepatik rezeksiyonun hacmi olarak bildirilmiştir. Sonuç olarak cerrahi tedavi yaklaşım tercihinde, her merkez kendi protokollerini hasta özelliklerini dikkate alarak multidisipliner bir şekilde belirlemelidir. 

Anahtar Kelimeler

• kolorektal kanser,karaciğer metastazı,cerrahi,cerrahi

Synchronous liver metastases of colorectal cancers: Our experience of combined surgical procedure

Öz

Aim: The most common metastasis of colorectal cancer (CRC) is the liver and approximately 25% of patients have synchronous liver metastases at the time of diagnosis. Surgical management of CRC patients with liver metastasis is still controversial. The treatment strategy for each patient should be personalized depending on the patient's performance status, comorbidities and tumor stage. The aim of this study was to determine our treatment approach for CRC patients with synchronous liver metastasis in our clinic and to compare them with the literature.

Material and Methods: Between January 2016 and December 2018, eight patients with synchronous liver metastatic CRC, combined surgical procedure called co-operated colorectal cancer surgery and hepatic resection were included in the study.

Results: Two patients underwent right hepatectomy and six patients underwent metastasectomy. T1 / 2 tumor was detected in one patient (12%) and T3 / 4 tumor in seven patients (88%) according to TNM stage. Four of the patients (50%) had lymph node metastasis. One patient died on the 3rd postoperative day due to MODS.

Conclusion: As in the results of our study, the most important criteria in patient selection for synchronous approach in literature are; The age of the patient and the volume of hepatic resection performed were reported. As a result, in the choice of surgical treatment approach, each center should determine its protocols in a multidisciplinary way considering the patient characteristics.

Anahtar Kelimeler

• liver metastasis,colorectal cancer,liver metastasis,surgery

Kaynakça

1. 1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: 359-86.
2. 2. McMillan DC, McArdle CS. Epidemiology of colorectal liver metastases. Surg Oncol 2007; 16: 3–5.
3. 3. Xu F, Tang B, Jin T-Q, Dai C-L. Current status of surgical treatment of colorectal liver metastases. World J Clin Cases 2018;6: 716–34.
4. 4. Line P-D, Hagness M, Dueland S. The Potential Role of Liver Transplantation as a Treatment Option in Colorectal Liver Metastases. Can J Gastroenterol Hepatol 2018; 2018: 8547940.
5. 5. Tsai M-S, Su Y-H, Ho M-C, Liang J-T, Chen T-P, Lai H-S, et al. Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis. Ann Surg Oncol 2007;14: 786–94.
6. 6. Ihnát P, Ostruszka P, Vávra P, Peteja M, Zonča P. Treatment strategies for patients with colorectal carcinomaand synchronous liver metastases. Rozhl V Chir Mesicnik Ceskoslovenske Chir Spolecnosti 2018;97: 451–54.
7. 7. Thelen A, Jonas S, Benckert C, Spinelli A, Lopez-Hänninen E, Rudolph B, et al. Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer. Int J Colorectal Dis 2007; 22: 1269–76.
8. 8. Sturesson C, Valdimarsson VT, Blomstrand E, Eriksson S, Nilsson JH, Syk I, et al. Liver-first strategy for synchronous colorectal liver metastases - an intention-to-treat analysis. HPB 2017;19: 52–8.

9. 9. Propensity score-matched outcomes analysis of the liver-first approach for synchronous colorectal liver metastases. - PubMed - NCBI [Internet]. [cited 2019 Apr 18]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26864820
10. 10. Le Souder EB, Azin A, Hirpara DH, Walker R, Cleary S, Quereshy F. Considering the cost of a simultaneous versus staged approach to resection of colorectal cancer with synchronous liver metastases in a publicly funded healthcare model. J Surg Oncol 2018 ;117:1376–85.
11. 11. Silberhumer GR, Paty PB, Denton B, Guillem J, Gonen M, Araujo RLC, et al. Long-term oncologic outcomes for simultaneous resection of synchronous metastatic liver and primary colorectal cancer. Surgery. 2016;160(1):67–73.
12. 12. Nanji S, Mackillop WJ, Wei X, Booth CM. Simultaneous resection of primary colorectal cancer and synchronous liver metastases: a population-based study. Can J Surg J Can Chir 2017;60: 122–28.
13. 13. Yin Z, Liu C, Chen Y, Bai Y, Shang C, Yin R et al. Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): Simultaneous or delayed? Hepatol Baltim Md 2013;57: 2346–57.