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Patients with multiple synchronous colonic cancer hepatic metastases benefit from enrolment in a “liver first” approach protocol

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World Journal of Hepatology 2014年第7期6卷 513-519页

作者： Dimitrios Kardassis achilleas ntinas Dimosthenis Miliaras Alexros Kofokotsios Konstantinos Papazisis Dionisios Vrochides Centre for Hepato-Pancreato-Biliary Surgery "Euromedica Ge-niki Kliniki" General Hospital 54645 Thessaloniki Greece Department of Pathology "Euromedica Geniki Kliniki" General Hospital 54645 Thessaloniki Greece Department of Interventional Gastroenterology "Euromedica Geniki Kliniki" General Hospital54645 Thessaloniki Greece Department of Medical Oncology "Eu-romedica Geniki Kliniki" General Hospital 54645 Thessaloniki Greece

AIM: To assess a protocol for treating patients with multiple synchronous colonic cancer liver metastases, which are unresectable in one stage. METHODS: Patients enrolled in the "liver first" protocol presented with colon-only(not rectal) cancer and multiple synchronous hepatic metastases(type Ⅱ or Ⅲ). All patients showed good performance status(ECOG PS 0-1) and were treated with curative intent. Complete oncologic staging including positron emission tomography-computed tomography was performed in order to rule out extrahepatic disease. If bowel obstruction was imminent, an intraluminal colonic stent was placed endoscopically. Subsequently, all patients received standardised neo-adjuvant chemotherapy, that is, FOLFOX or XELOX regimens combined with an antiangiogenic agent(bevacizumab or cetuximab). Provided that a response to chemotherapy was observed, patients underwent either one or two hepatectomies with or without portal vein embolization followed by the indicated colectomy. Further chemotherapy was administered after each procedure. Re-staging was performed after each chemotherapeutic treatment. Disease progression at any stage resulted in discontinuation of the protocol and conversion to palliative disease ***: Prospectively recorded data from 11 consecutive patients(8 men) were analysed for this study. Their mean age at the time of their first assessment was 65.7(SD ± 15.3) years. Six(54.6%) patients presented with type Ⅲ metastatic disease. The minimum and maximum follow-up periods were 7.3 and 39.6 mo, respectively. The mean overall survival of all patients was 16.5(95%CI: 10.0-23.2) mo. A colonic stent had to be placed in 5(45.5%) patients due to the onset of an intraluminal obstruction. Four(36.4%) patients succeeded in completing all planned surgical operations. Their mean overall survival was 27.2(95%CI: 15.1-39.3) mo and the mean disease-free survival was 7.7(95%CI: 3.0-12.5) mo. Patients, who were obliged to shift to palliative treatmen

关键词： Clinical protocols Colectomy Colon cancer Hepatectomy Liver neoplasm

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