Reverzný prístup k synchrónnym pečeňovým metastázam kolorektálneho karcinómu
Absolvovanie liečebného protokolu, strednodobé (trojročné) prežívanie a vzorec progresie ochorenia u 32 pacientov
Authors:
M. Straka 1,2,4; M. Migrová 1,2; R. Soumarová 2,3; L. Burda 1,2; I. Selingerová 5
Authors‘ workplace:
Chirurgické oddělení Nemocnice Nový Jičín
primář: MUDr. M. Škrovina, Ph. D.
1; Komplexní onkologické centrum Nemocnice Nový Jičín
vedoucí pracoviště: doc. MUDr. R. Soumarová, Ph. D., MBA
2; Oddělení radioterapie a onkologie Nemocnice Nový Jičín
vedoucí pracoviště: doc. MUDr. R. Soumarová, Ph. D., MBA
3; Vzdělávací a výzkumný institut AGEL o. p. s., Prostějov
ředitelka: Ing. Mgr. K. Murtingerová
4; Přírodovědecká fakulta Masarykovy univerzity Brno, Ústav matematiky a statistiky a MOÚ Brno
ředitel: prof. RNDr. J. Slovák, Dr. Sc.
5
Published in:
Rozhl. Chir., 2016, roč. 95, č. 7, s. 280-286.
Category:
Original articles
Overview
Introduction:
Reverse, liver-first strategy is an alternative for patients with complicated liver metastases where disease progression would prove inoperable, or for patients with locally advanced pelvic disease where postoperative complications after primary tumour resection may lead to delayed treatment of metastatic disease.
Methods:
Retrospective unicenter analysis of 32 patients approached liver-first approach between 2011 and 2015. During this period reverse strategy was considered a preferred approach for all initially or potentially resectable synchronous colorectal liver metastases based on multidisciplinary team consensus.
Results:
26 patients (81.3%) completed their surgical plan (hepatectomy and primary tumour resection) but only 16 (50%) completed their oncosurgical plan (hepatectomy, primary tumour resection and full dose and length of perioperative or adjuvant systemic (bio)chemotherapy). Median overall survival was 50.5 months with the survival rate of 83.7% at 3 years. 20 patients (62.5%) progressed during the follow-up with median time to progression of 21.6 months. The liver was the most common site of recurrent disease followed by the lungs (65% and 20% of all recurrences, respectively).
Conclusion:
While reverse strategy may allow complete tumour removal in the majority of patients, only half of them complete their oncosurgical plan even with the liver-first approach. The most problematic aspect of the liver-first strategy is the timing and length of perioperative (bio)chemotherapy. When deciding on preoperative chemotherapy in up-front resectable lesions one should take into account the risk of disease progression while on chemotherapy as well as the risks of complete radiologic response.
Key words:
colorectal carcinoma − reverse strategy − liver-first approach − liver metastases
Sources
1. Chua TC, Saxena A, Chu F, et al. Predictors of cure after hepatic resection of colorectal liver metastases: an analysis of actual 5- and 10-year survivors. J Surg Oncol 2011;103:796−800.
2. Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25:4575−80.
3. Scheele J, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 1990;77:1241−6.
4. Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230:309-18; discussion 318−21.
5. Donadon M, Ribero D, Morris-Stiff G, et al. New paradigm in the management of liver-only metastases from colorectal cancer. Gastrointest Cancer Res 2007;1:20−7.
6. Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 2008;371:1007−16.
7. Patrlj L, Kopljar M, Kliček R, et al. The surgical treatment of patients with colorectal cancer and liver metastases in the setting of the liver first approach. Hepatobiliary Surg Nutr 2014;3:324−9.
8. Mentha G, Majno PE, Andres A, et al. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg 2006;93:872−8.
9. Jegatheeswaran S, Mason JM, Hancock HC, et al. The liver-first approach to the management of colorectal cancer with synchronous hepatic metastases: a systematic review. JAMA Surg 2013;148:385−91.
10. Kardassis D, Ntinas A, Miliaras D, et al. Patients with multiple synchronous colonic cancer hepatic metastases benefit from enrolment in a liver first approach protocol. World J Hepatol 2014;6:513−9.
11. Donati M, Stavrou GA, Stang A, et al. Liver-first pproach for metastatic colorectal cancer. Future Oncol 2015;11:1233−43.
12. Waisberg J, Ivankovics IG. Liver-first approach of colorectal cancer with synchronous hepatic metastases: A reverse strategy. World J Hepatol 2015;7:1444−9.
13. Ihnát P, Vávra P, Zonča P. Treatment strategies for colorectal carcinoma with synchronous liver metastases: Which way to go? World J Gastroenterol 2015;21:7014−21.
14. Baltatzis M, Chan AK, Jegatheeswaran S, et al. Colorectal cancer with synchronous hepatic metastases: Systematic review of reports comparing synchronous surgery with sequential bowel-first or liver-first approaches. Eur J Surg Oncol 2016;42:159−65.
15. Lam VW, Laurence JM, Pang T, et al. A systematic review of a liver-first approach in patients with colorectal cancer and synchronous colorectal liver metastases. HPB (Oxford) 2014;16:101−8.
16. Gall TM, Basyouny M, Frampton AE, et al. Neoadjuvant chemotherapy and primary-first approach for rectal cancer with synchronous liver metastases. Colorectal Dis 2014;16:O197−205.
17. Andres A, Toso C, Adam R, et al. A survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases: a LiverMetSurvey-based study. Ann Surg 2012;256:772−8; discussion 778−9.
18. Lykoudis PM, O´Rilly D, Nastos K, et al. Systematic review of surgical management of synchronous colorectal liver metastases. Br J Surg 2014;101:605−12.
19. Kelly ME, Spolverato G, Lê GN, et al. Synchronous colorectal liver metastasis: a network meta-analysis review comparing classical, combined, and liver-first surgical strategies. J Surg Oncol 2015;111:341−51.
20. Mentha G, Roth AD, Terraz S, et al. „Liver first“ approach in the treatment of colorectal cancer with synchronous liver metastases. Dig Surg 2008;25:430−5.
21. Verhoef C, van der Pool AE, Nuyttens JJ, et al. The „liver-first approach“ for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum 2009;52:23−30.
22. Brouquet A, Mortenson MM, Vauthey JN, et al. Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined or reverse strategy? J Am Coll Surg 2010;210:934−41.
23. de Jong MC, van Dam RM, Maas M, et al. The liver-first approach for synchronous colorectal liver metastasis: a 5-year single-centre experience. HPB (Oxford) 2011;13:745−52.
24. Pudil J, Batko S, Menclová K, et al. [“Liver fist approach“ in the management of synchronous liver metastases from colorectal cancer: Preliminary non-randomized study results]. Czech, Rozhl Chir 2015;94:522−5.
25. Tanaka K, Murakami T, Matsuo K, et al. Preliminary results of ‘liver-first‘ reverse management for advanced and aggressive synchronous colorectal liver metastases: a propensity-matched analysis. Dig Surg 2015;32:16−22.
26. Choti MA. Defining resectable metastatic CRC: indications, outcomes, and controversies. In: Marshall JA, Choti MA, editors. Managing CRC: the resectable and potentially resectable patient-A multidisciplinary approach. New Jersey, CMPMedica-United Business Media 2008:9–15.
27. Van Cutsem E, Cervantes A, Nordlinger B, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25 Suppl 3:iii1-9. doi: 10.1093/annonc/mdu260.
28. Grundmann RT, Hermanek P, Merkel S, et al. Arbeitsgruppe Workflow Diagnostik und Therapie von Lebermetastasen kolorektaler Karzinome. Zentralbl Chir 2008;133:267−84.
29. Benoist S, Brouquet A, Penna C, et al. Complete response of colorectal liver metastases after chemotherapy: does it mean cure? J Clin Oncol. 2006;24:3939−45.
30. Passot G, Odisio BC, Zorzi D, et al. Eradication of missing liver metastases after fiducial placement. J Gastrointest Surg 2016; Jan 20. [Epub ahead of print]
31. Třeška V, Skalický T, Ferda J, et al. [Colorectal liver metastases surgery - the present and the perspectives] Czech, Rozhl Chir 2014;93:568−71.
32. Viganò L, Capussotti L, Lapointe R, et al. Early recurrence after liver resection for colorectal metastases: risk factors, prognosis, and treatment. A LiverMetSurvey-based study of 6,025 patients. Ann Surg Oncol 2014;21:1276−86.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2016 Issue 7
Most read in this issue
- Juxtapapillary duodenal diverticulum causing pancreatobiliary problems - case report and literature review
- Cecal herniation through the foramen of Winslow as a rare cause of ileus
- Parametric monitoring of the quality of total mesorectal excision and surgical treatment of rectal carcinoma − results of a multicenter study
- Special contact splints in postoperative care for patients with the diabetic foot