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palliative care and end-stage colorectal cancer management:The surgeon meets the oncologist

World Journal of Gastroenterology 2014年第24期20卷 7602-7621页

作者： Renato Costi Francesco Leonardi daniele.zanoni Vincenzo Violi Luigi Roncoroni Istituto di Clinica Chirurgica Generale e Terapia Chirurgica Dipartimento di Scienze ChirurgicheUniversità di ParmaAzienda Ospedaliero-Universitaria di Parma43126 ParmaItaly Dipartimento Polispecialistico 1 Unità Operativa di Oncologia MedicaAzienda Ospedaliero-Universitaria di Parma43126 ParmaItaly Dipartimento di Chirurgia Generale e Specialistica Ospedale di VaioAzienda Unità Sanitaria Locale di Parma43036 Fidenza (Parma)Italy

Colorectal cancer(CRC)is a common neoplasia in the Western countries,with considerable morbidity and mortality.Every fifth patient with CRC presents with metastatic disease,which is not curable with radical intent in roughly 80%of cases.Traditionally approached surgically,by resection of the primitive tumor or stoma,the management to incurable stageⅣCRC patients has significantly changed over the last three decades and is nowadays multidisciplinary,with a pivotal role played by chemotherapy(CHT).This latter have allowed for a dramatic increase in survival,whereas the role of colonic and liver surgery is nowadays matter of debate.Although any generalization is difficult,two main situations are considered,asymptomatic(or minimally symptomatic)and severely symptomatic patients needing aggressive management,including emergency cases.In asymptomatic patients,new CHT regimens allow today long survival in selected patients,also exceeding two years.The role of colonic resection in this group has been challenged in recent years,as it is not clear whether the resection of primary CRC may imply a further increase in survival,thus justifying surgeryrelated morbidity/mortality in such a class of shortliving patients.Secondary surgery of liver metastasis is gaining acceptance since,under new generation CHT regimens,an increasing amount of patients with distant metastasis initially considered non resectable become resectable,with a significant increase in long term survival.The management of CRC emergency patients still represents a major issue in Western countries,and is associated to high morbidity/mortality.Obstruction is traditionally approached surgically by colonic resection,stoma or internal by-pass,although nowadays CRC stenting is a feasible option.Nevertheless,CRC stent has peculiar contraindications and complications,and its long-term cost-effectiveness is questionable,especially in the light of recently increased survival.Perforation is associated with the highest mortality and remains mostly matter for surgeons,by

关键词： Colorectal cancer Palliative care Multimodal treat

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