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1.
Treatment strategy for synchronous metastases of colorectal cancer: is hepatic resection after an observation interval appropriate? 总被引:1,自引:1,他引:0
Yasuhiro Shimizu Kenzo Yasui Tsuyoshi Sano Takashi Hirai Yukihide Kanemitsu Koji Komori Tomoyuki Kato 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(5):535-538
Background In cases of synchronous colorectal hepatic metastases, the primary colorectal cancer strongly influences on the metastases.
Our treatment policy has been to conduct hepatic resection for the metastases at an interval of 3 months after colorectal
resection. We examined the appropriateness of interval hepatic resection for synchronous hepatic metastasis.
Materials and methods The subjects were 164 patients who underwent resection of hepatic metastasis of colorectal cancer (synchronous, 70 patients;
metachronous, 94 patients). Background factors for hepatic metastasis and postoperative results were compared for synchronous
and metachronous cases.
Results The cumulative survival rate for 164 patients at 3, 5, and 10 years postoperatively was 71.9%, 51.8%, and 36.6%, and the post-resection
recurrence rate in remnant livers was 26.8%. Interval resection for synchronous hepatic metastases was conducted in 49 cases
after a mean interval of 131 days. No difference was seen in postoperative outcome between synchronous and metachronous cases.
Conclusion The outcome was similarly favorable in cases of synchronous hepatic metastasis and in cases of metachronous metastasis. Delaying
resection allows accurate understanding of the number and location of hepatic metastases, and is beneficial in determining
candidates for surgery and in selecting surgical procedure. 相似文献
2.
Yasuhiro Shimizu Kenzo Yasui Tsuyoshi Sano Takashi Hirai Yukihide Kanemitsu Koji Komori Tomoyuki Kato 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2008,393(2):181-184
Background In cases of synchronous colorectal hepatic metastases, the primary colorectal cancer maintains a strong influence on the metastases,
so the possibility of occult hepatic and extrahepatic metastases must be kept in mind. Our treatment policy has been to reevaluate
the metastases at an interval of 3 months after colorectal resection and determine treatment strategy. We examined the validity
of observation interval for synchronous hepatic metastases.
Materials and methods The treatment course was investigated for 36 patients with no extrahepatic lesion remnants at colorectal surgery and a simultaneously
resectable liver (H1 group).
Results In the H1 group, eight patients underwent simultaneous colorectal and hepatic resections, while the treatment course for 28
patients was decided after an interval. Hepatic resection was not indicated in nine of the 28 patients during the interval.
New lesions appeared during the interval in seven of 19 interval hepatic resection patients. In 16 (57%) of 28 interval patients,
there was a change in the hepatic resection procedure or surgical indications.
Conclusion Reevaluation after an observation interval allows accurate understanding of the number and location of hepatic metastases
and is beneficial in determining candidates for surgery and in selecting treatment plan. 相似文献
3.
Background : Despite the widespread use of surgical resection as a treatment for hepatic colorectal metastases, the value of resecting more than three metastases remains controversial. It was the objective of this study to determine if resection of larger numbers of metastases affects patient survival. Method : The survival of 123 consecutive patients who underwent curative hepatic resection for colorectal metastases between 1989 and 1999 by a single surgeon was analysed retrospectively. Kaplan–Meier survival statistics and Cox regression were used to determine the factors that affected survival, and logistic regression was used to determine the factors that affected the risk of recurrence of hepatic disease. Results : The median survival rate for the whole group of patients was 38 months, with 1, 3 and 5 year survival rates of 88%, 53% and 31% respectively. The survival rate of patients undergoing resection of four to seven metastases (n = 22; 5 year survival = 39%) was not significantly different to that of patients undergoing resection of one to three metastases (n = 91; 5 year survival = 30%), P = 0.9. Age, sex, primary cancer site, hepatic disease distribution, resection margins and adjuvant hepatic arterial chemotherapy (HAC) did not affect survival. Local invasion of the hepatic metastases (relative risk (RR) = 2.9; P = 0.001) and hepatic disease recurrence (RR = 2.1; P = 0.007) were the only factors that independently affected survival. Local invasion of the hepatic metastasis was the only factor associated with an increased risk of hepatic recurrence (RR = 2.8; P = 0.03). Adjuvant HAC did not affect the risk of hepatic recurrence (RR = 1.5, P = 0.4). Conclusion : Although there are no randomized trials that quantify any survival benefit from resection of liver metastases, the comparison of our results with well documented historical evidence indicates that surgical resection of up to seven colorectal liver metastases can result in a significant survival benefit. 相似文献
4.
Repeat hepatic cryotherapy for metastatic colorectal cancer 总被引:3,自引:0,他引:3
Mathew H. Chung M.D. Wei Ye M.S. Kenneth P. Ramming M.D. Anton J. Bilchik M.D. Ph.D. 《Journal of gastrointestinal surgery》2001,5(3):287-293
This study evaluated the risks and benefits of repeat hepatic cryotherapy for recurrent, unresectable hepatic metastases from
colorectal carcinoma. Review of a prospective database identified 195 patients who underwent hepatic cryotherapy for metastatic
colorectal carcinoma during a 7-year period. Of the 14 patients who underwent successful repeat cryotherapy for recurrences
confined to the liver, 86% had Duke’s stage D colorectal carcinoma at initial diagnosis. The median age of the 14 patients
was 58 years (range 41 to 77 years). The median number of hepatic metastases was three at the first cryotherapy and two at
the second cryotherapy. At a median follow-up of 71 months, the mean survival times from original diagnosis, first cryotherapy,
and second cryotherapy were 53,42, and 19 months, respectively. At the most recent follow-up, eight patients (57%) have died
of their disease, four (29%) are alive with disease, and two (14%) have no evidence of disease. The mean interval between
the first and second cryotherapies was 23 months. The complication rates after the first and second cryotherapies were 7%
and 14%, respectively. One patient developed a wound dehiscence after the first cryotherapy. Following the second cryotherapy,
one patient had a small bowel obstruction and another had a pleural effusion. There was no perioperative mortality. Repeat
cryotherapy for recurrent, unresectable hepadc metastases from colorectal cancer is safe and improves survival. However, a
prospective trial is needed to validate the efficacy of systemic therapy and to better define the indications for repeat hepatic
cryotherapy.
Supported in part by grant T32 CA 09689 from the National Cancer Institute and by funding from the Rogovin-Davidow Foundation,
Los Angeles, Calif.
Presented at the Forty-First Annual Meeting of The Society for Surgery of the Alimentary Tract, San Diego, Calif., May 2l–24,
2000. 相似文献
5.
Repeat hepatectomy for colorectal metastases 总被引:1,自引:0,他引:1
Paul H. Sugarbaker 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(1):30-38
The utility of repeat hepatectomy for patients with colorectal metastases to the liver was sought. A complete review of the
results of surgical treatment of patients having a repeat hepatectomy was presented. Then, the data on 170 patients in whom
multiple clinical variables had been tabulated were selected for special study. These statistical analyses showed that there
were no special clinical features present at the time of primary resection of the large bowel cancer that could distinguish
these patients. There were some differences in the clinical features of these patients at the time of first and second liver
resections. The disease-free interval, method of diagnosis, presence of extrahepatic disease, incidence of complete resection,
and postoperative morbidity showed significant differences. The 5-year survival of the group as a whole was 32%. Only those
clinical features which involved the completeness of cancer resection had a significant impact on survival. To optimize selection
for a long-term survival, no extrahepatic disease should be present and the second hepatectomy should involve removal of all
visible tumor. Repeat hepatectomy for colorectal metastases was thought to be justified if the patient was made clinically
disease-free, because surgery remains the only potentially curative treatment. The repeat hepatectomy was relatively safe
with a low morbidity and conferred a 32% long-term survival.
Received for publication on Aug. 30, 1998; accepted on Nov. 2, 1998 相似文献
6.
Ralph J. Doerr Mahmoud N. Kulaylat Hani Abdel-Nabi 《Journal of Hepato-Biliary-Pancreatic Surgery》1995,2(2):126-133
Approximately two-thirds of metastatic lesions that develop following curative resection of colorectal cancer occur in the
liver and lung. In select groups of patients, resection of these lesions is associated with increased 5-year survival. In
the liver, precise preoperative documentation of the presence, location, number, and relationship of these lesions to vascular
structure is crucial in the selection of candidates for curative resection. Computed tomography with arterial portography
(CTAP), intraoperative ultrasonography (IOUS), positron emission tomographic (PET) scan, and radionuclide scanning, including
radiolabeled monoclonal antibody imaging, are emerging as the procedures of choice in the preoperative and intraoperative
evaluation of metastatic colorectal cancer to the liver. 相似文献
7.
目的:总结和分析大肠癌肝转移的早期诊断和手术治疗。方法:通过对大肠癌肝转移病例进行回顾性分析,讨论大肠癌的早期诊断及外科手术切除治疗等相关问题。结果:18例中,依靠CT、B超及CEA定量检测获得诊断者10例,术中探查获得诊断者8例。手术方式分为肝段切除、肝楔形切除及肿瘤剜出术。生存5年者2例,生存4年者3例,生存3年者5例,生存2年者5例,生存1年者3例。结论:手术治疗是大肠癌肝转移最有效 的治疗方法,主流术式应为不规则肝切除,切缘距肿瘤>1.0cm为大肠癌肝转移的根治性切除术。 相似文献
8.
M. Eberwein R. Prommegger M. Oberwalder A. Unger A. Klingler K. Glaser J. Tschmelitsch M.D. 《European Surgery》1998,30(4):242-246
Summary
Background: The aim of this paper is to analyze our experience with liver resection for metastatic colorectal cancer and to evaluate
the prognostic significance of various parameters.
Methods: 40 consecutive patients treated with potentially curative liver resection between 1984 and 1996 were included. The prognostic
significance of various parameters was evaluated with respect to survival. Univariate and multivariate analyses were performed
for following factors: age, gender, site and stage and grading of the primary tumor, size of metastases, number of metastases,
lobar distribution of metastases, diagnostic interval, type of liver resection, resection margin, perioperative blood transfusion
and preoperative carcinoembryonic antigen (CEA) level.
Results: 3-year- and 5-year survival was 54% and 33%, median survival was 37 months. The 30 day mortality rate was 0%, postoperative
complications occurred in 8 patients (20%). As single factors the following significantly affected the prognosis: number of
metastases (p=0.0001), mesenteric lymphnode involvement of the primary tumor (p=0.002), lobar distribution (p=0.002) and intraoperative
units of blood (p=0.05).
Multivariate analysis revealed that age, gender, mesenteric lymphnode involvement, number of metastases and synchronous versus
metachronous metastatic disease were independent predictors of survival.
Conclusions: Liver resection is effective in selected patients with hepatic metastases from colorectal cancer. In resectable patients
it is not possible to establish a clear prognosis based on the investigated factors. Therefore, patients with adverse prognostic
factors should not be denied resection.
相似文献
9.
目的 探讨结直肠肿瘤肝转移的外科治疗意义。方法 回顾性分析经手术切除和病理证实的39例结直肠肿瘤肝转移患者的临床资料。结果 全组无于术死亡.均治愈出院。随访37例,存活时间6个月~4年。结论 对于结直肠肿瘤肝转移有适应证的患者手术有明确的疗效。 相似文献
10.
We describe the treatment strategy for multiple hepatic metastases of colorectal carcinoma based on a review of the literature
and our own results. Although a number of studies have suggested that multiplicity or bilobar distribution of metastases is
associated with poor outcome, liver resection is thought to be the only potentially curative treatment. The only contraindications
to surgery are the presence of extrahepatic metastases (with the exception of resectable lung metastases) and if radical removal
of all detectable tumors is not possible. Hepatectomy should be performed with the aim of maintaining a delicate balance between
radical removal of tumors and the preservation of as much residual hepatic mass as possible with minimal blood loss. Surgeons
should be familiar with the use of intraoperative ultrasonography, a standard adjunct to liver resection. Preoperative portal
vein embolization may be indicated in selected patients as a means of inducing hypertrophy in the remaining hepatic parenchyma.
Received for publication on Aug. 30, 1998; accepted on Nov. 2, 1998 相似文献
11.
Wing‐Hong Li Moon‐Tong Cheung Candace N.S. Ho Ting‐Pong Fung Kai‐Ming Ko Kelvin K.W. Yau 《Surgical Practice》2007,11(4):138-143
Aim: To examine the survival benefit of liver and lung resection for colorectal metastasis and the potential prognostic factors that affect patient survival. Methods: All patients who had resection of lung or liver metastasis for colorectal metastasis in Queen Elizabeth Hospital, Hong Kong from 1995 to 2004 were retrospectively reviewed. The overall and disease‐free survival was analysed, in particularly between liver and lung metastasis. All factors that may have affected the survival were entered into Cox's proportional hazards regression model to identify significant variables associated with survival. Results: At 5 years, the overall survival of patients who had resection of lung and liver metastasis was 44% and 38%, respectively; the disease‐free survival was 26% and 24%, respectively. Overall and disease‐free survival of patients with resection of lung metastasis was comparable to those with resection of liver metastasis. The differentiations of primary tumour and time to metastasis were shown to be significant prognostic factors influencing overall survival. Those patients with systemic chemotherapy after resection of colorectal metastasis demonstrated a significantly higher probability of overall survival. Conclusion: Resection of lung and liver metastases from colorectal origin was safe and both procedures improved survival. The use of chemotherapy after resection of metastasis significantly improved the overall survival. 相似文献
12.
Glenn Steele Jr Robert J. Mayer Anne Lindblad 《Journal of Hepato-Biliary-Pancreatic Surgery》1995,2(2):122-125
Single institution studies of hepatic resection have implied that some subsets of patients with metastases from colon and
rectum adenocarcinoma can be cured by surgery. However, it is unknown how such patients can be selected and what, in fact,
the ultimate cure rate is. The objective of this multi-institutional study was to define in a prospective manner how many
patients predicted to have resectable liver metastases actually could undergo curative resection and what the disease-free
and overall survival were. A prospective 15-institution treatment plan included all patients who were predicted to have resectable
metastases from colon and rectum cancer primaries. Results were compared among patients who underwent successful resection,
patients who underwent resection with pathologically defined inadequate margins, and patients who underwent exploration but
were found at surgery not to have resectable liver metastases. Fourteen institutions throughout North America and one in Milan
who were members of the Gastrointestinal Tumor Study Group at the inception of this protocol in July of 1984 participated
in the study. The patient population consisted of all those with metachronous or synchronous metastases from colon or rectum
adenocarcinoma seen during a consecutive 3 1/2 year period with protocol registry at the time liver metastases were predicted
to be isolated and resectable. Intervention consisted of the application of standard preoperative screening tests, abdominal
exploration, and resection of all patients who had liver-only surgically resectable disease. The main outcome measures were:
Accuracy of preoperative staging, acute and chronic operative morbidity, and disease-free, as well as overall, survival among
the three treatment groups. The minimum follow up on all surviving patiens after curative resection was 2.2 years, with a
median follow up of 3.2 years. Median survival times for patients receiving curative and noncurative resections and for those
receiving no resection were estimated to be 35.7, 21.2, and 16.5 months, respectively. No statistically significant difference
in the survival distribution of the noncuratively resected or the non-resected patients was observed. The survival distribution
of curatively resected patients remains statistically superior to the distribution of noncuratively resected patients and
those receiving no resection (P=0.01). These results confirmed that, although liver resection for hepatic metastases from colorectal car cinoma is safe to
do and presently constitutes the only standard curative treatment for potentially resectable disease, it ultimately cures
few patients. 相似文献
13.
Yonson Ku Masahiro Tominaga Takeshi Iwasaki Tetsushi Kitagawa Ichiro Maeda Masafumi Shiotani Shinya Kusunoki Yoko Maekawa Masahiro Samizo Takumi Fukumoto Yoshikazu Kuroda Shozo Hirota Yoichi Saitoh 《Surgery today》1996,26(5):305-313
The results of treating 12 consecutive patients with unresectable colorectal hepatic metastases with a hepatic arterial infusion of high-dose Adriamycin, 100–120 mg/m2, using hepatic venous isolation (HVI) and charcoal hemoperfusion (CHP) are reported herein. Adriamycin was administered over 5–15 min under extracorporeal drug elimination by HVI-CHP. HVI was percutaneously accomplished by either the double-balloon technique using a Fogarty occlusion catheter (8/22F) or a balloon-tipped catheter (16F). During the infusion, isolated hepatic venous blood was filtered by CHP and pumped into the left axillary vein. There were no lethal complications, and good hemodynamic tolerance to HVI-CHP was confirmed. Tumor liquefaction accompanied by a sharp decrease in serum carcinoembryonic antigen levels by more than 50% of pretreatment levels was observed in 6 of the 12 patients 1 month after treatment. Apart from chemical hepatitis, which developed in 11 (92%) of the patients, the Adriamycin toxicities were well controlled following the development of nausea and vomiting in 2 patients (17%), leukopenia <2,000/mm3 in 3 (25%), and gastric ulcer in 1 (8%). These results indicate that this method is a safe and useful procedure for otherwise hazardous high-dose intraarterial chemotherapy in patients with unresectable hepatic tumors. 相似文献
14.
Todd M. Tuttle MD Steven A. Curley MD Dr. Mark S. Roh MD 《Annals of surgical oncology》1997,4(2):125-130
Background: Approximately 20–40% of patients who undergo liver resection for colorectal metastases develop recurrent disease confined to the liver. The goals of this study were to determine whether the survival benefit of repeat hepatic resection justified the potential morbidity and mortality.
Methods: A retrospective review was performed on all patients who underwent liver resection for colorectal cancer metastases between 1983 and 1995 (N=202). Repeat liver resections were performed on 23 patients for recurrent metastases.
Results: There were no operative deaths in the 23 patients, and the postoperative morbidity rate was 22%. The 5-year actuarial survival rate after repeat resection was 32%, with a median length of survival of 39.9 months. There were three patients who survived for >5 years after repeat resection. Sixteen patients (70%) developed recurrent disease at a median interval of 11 months after the second resection; 10 of these 16 patients (62%) had new hepatic metastases. No clinical or pathological factors were significant in predicting long-term survival.
Conclusions: Repeat liver resection for recurrent colorectal metastases (a) can be performed safely with acceptable mortality and morbidity rates and (b) may result in long-term survival in some patients.Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996. 相似文献
15.
Tsuneyuki Yoshida Shinji Ohki Masashi Kanazawa Hiroshi Mizunuma Youichi Kikuchi Hisayoshi Satoh Yoshiroh Andoh Atsuo Tsuchiya Rikiya Abe 《Surgery today》1998,28(7):740-745
The inhibitory action of prostaglandin D2 (PGD2) and its effect on the cell cycle were examined in cell lines SW480 and LS174T of human colon cancer. The growth of the cell
lines were assessed 24h and 48h after the addition of 1.0μg/ml and 10.0μg/ml PGD2. The growth of SW480 cells and 24h and 48h after the addition of 10.0μ/ml, while that of LS174T was inhibited by both doses
after 24h and 48h. S-Phase DNA synthesis in the SW480 cells was significantly blocked 24h after the addition of 10.0μg/ml
PGD2. The cell cycle of LS174T cells was arrested at the G0+G1 phase 24h after the addition of 1.0μg/ml and 10.0μg/ml PGD2. The correlation between hepatic metastasis and PGD2 concentration in human cancer tissue was examined. The mean value of PGD2 concentrations in the primary cancer tissue was significantly lower in the hepatic metastasis group than that in the group
without hepatic metastasis. These findings suggest that measuring the PGD2 in cancer tissue may be useful for detecting and predicting the hepatic metastasis from human colorectal cancer. 相似文献
16.
Background : Isolated pulmonary metastases from colorectal cancer are rare. The present study reports on the 15‐year experience of the Royal Prince Alfred Unit and discusses means of improving survival outcomes. Methods : This was a retrospective review, over a 15‐year period, of 41 patients who had resectable pulmonary metastases of colorectal origin. Results : Most were asymptomatic at the time of diagnosis. Seventy‐two per cent had solitary metastases. The most common procedure performed was a lobectomy. Median follow up was 21 months. Five‐year survival was 24%. There were no significant prognostic indicators except for the ability to achieve clear surgical margins. Conclusion : Morbidity and mortality have not altered significantly over time. But an improved selection process such as the use of preoperative positron emission tomography will potentially improve survival outcomes. 相似文献
17.
目的 :用电穿击化疗对异位移植裸小鼠人结直肠肿瘤肝转移模型进行治疗 ,探讨其疗效和机制。方法 :将 4 0只皮下人结肠癌LoVo细胞系肿瘤的裸鼠随机分成 1 0区组 ,每区组 4只 ,随后将每区组的小鼠分至电穿击化疗组、化疗组、电击组、阴性对照组 ,并给予相应的治疗。 1w后处死小鼠 ,观察瘤重及病理改变情况。结果 :电穿击化疗组小鼠的肿瘤显著减小 ,其中有一只小鼠的肿瘤完全消失 ,平均瘤重为 1 8.3mg ,与其余各组平均瘤重 (化疗组 36 .9mg、电击组 37.9mg、阴性对照组 4 2 .7mg)相比在统计学上差异有显著性 ,P<0 .0 1。光镜下可见电穿击化疗组的肿瘤组织有大量片状坏死、炎性细胞浸润、血管的扭曲及内皮的脱落和坏死 ,而化疗组和电击组则仅见少量炎性细胞的浸润和单个细胞的坏死。结论 :电穿击化疗可以显著增强肿瘤对化疗的敏感性 ,为人结直肠肿瘤肝转移的治疗提供了一种新的途径 相似文献
18.
《Urological Science》2015,26(1):72-74
Paratesticular tumors are rare, especially when they are metastatic. Most of them originate in the prostate, kidney, gastrointestinal tract, lung, and breast. The most common site of metastasis from the gastrointestinal tract is the colon. A 75-year-old male presented with a painless and tense right scrotal mass. He underwent a radical right orchiectomy, and the pathology revealed mucinous cystadenocarcinoma of the paratesticular tissue. Computed tomography revealed focal wall thickening at the rectosigmoid junction and liver nodules. The colonoscopic biopsy of the mass showed adenocarcinoma. Immunohistochemical staining of both sites confirmed the diagnosis of colorectal adenocarcinoma metastatic to the scrotum. 相似文献
19.
The routine use of intra-operative ultrasound in patients with colorectal cancer improves the detection of hepatic metastases 总被引:2,自引:0,他引:2
INTRODUCTION: Up to one fifth of patients with carcinoma of the colon have occult liver metastases at the time of presentation. Intra-operative hepatic ultrasonography might improve disease staging. We report the use of intra-operative ultrasonography (IOUS) in routine clinical practice over a five-year period. METHOD: Seventy-six patients with colorectal carcinoma (F 21, M 55) of median age 67 years (range 43-89 years) for whom full data were available had IOUS at the time of colonic resection. All patients had had a computerized tomography (CT), magnetic resonance imaging (MRI) or ultrasonography (USS). RESULTS: Of 76 patients, 10 had a Dukes A, 32 had a Dukes B and 34 a Dukes C carcinoma. In 20 patients IOUS detected lesions not seen on pre-operative scanning including 11 metastases (one suitable for resection), seven benign hepatic cysts and two were benign hepatic nodules. Forty-nine patients have remained free of disease and 25 have died with systemic disease (mean survival 10 months, range 2-24 months). In the seven patients diagnosed as having hepatic cysts at IOUS two have died of systemic disease. The remaining patients (n=12) who died with systemic disease had a negative IOUS. CONCLUSION: IOUS increases diagnostic yield but a significant proportion of patients with occult hepatic metastases are not detected. IOUS improves disease staging in some patients refining the indications for adjuvant therapy and enhancing the estimate of prognosis and improving decision-making. 相似文献
20.
目的评价肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗胃癌肝转移的临床疗效、毒副反应及生活质量的改善情况。方法收集31例同时性胃癌伴肝转移患者的临床资料,行TACE治疗。结果全组患者完全缓解(CR)4例,占12.9%;部分缓解(PR)17例,占54.8%;病变稳定(SD)6例,占19.4%;病变进展(PD)4例,占12.9%,总有效率(CR+PR)为67.7%。结论针对胃癌肝转移患者,TACE治疗是有效的。 相似文献