Patients Operated On for Initially Unresectable Colorectal Liver Metastases With Missing Metastases Experience a Favorable Long-Term Outcome
Patients Operated On for Initially Unresectable Colorectal Liver Metastases With Missing Metastases Experience a Favorable Long-Term Outcome
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DOI：
10.1097/sla.0b013e31821ad704
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发表时间：
2011-07-01
影响因子：
9
通讯作者：
Elias, Dominique
中科院分区：
文献类型：
--
作者：
Goere, Diane;Gaujoux, Sebastien;Elias, Dominique
背景资料：化疗后，结直肠癌肝转移（CRLM）的完全临床反应越来越多，但这些反应很少是完全的病理反应。转移瘤丢失患者的治疗仍然存在争议，转移瘤丢失患者在化疗过程中CRLM消失，术中检测不到，最终留在原位。本研究的目的是评估“CRLM缺失”患者的长期结局。“患者：在1999年至2007年期间，在523例CRLM手术患者中，观察到96例CRLM缺失，并在27例最初不可切除的患者中保留原位。所有患者均接受术前化疗。23例肝切除术后患者，术前12例，术后11例，均行奥沙利铂联合5-氟尿嘧啶肝动脉灌注（HAI）。在CRLM在影像学上消失的最短间隔3个月后进行肝脏手术。肝脏手术后中位随访55个月（24-137）后，14例（52%）患者诊断为肝内复发，但接受辅助HAI的患者复发率明显低于其他患者（27%对83%，P = 0.006）。9例（33%）患者的CRLM缺失部位出现复发，但所有病例均与肝脏复发相关。27例化疗高敏感患者的5年总生存率为80%，5年无瘤生存率为23%。结论：化疗高敏感患者中，最初不能切除的CRLM因CRLM缺失而可切除，其长期预后良好。CRLM缺失不应更长，这是肝脏手术的禁忌症。奥沙利铂术后HAI的使用有助于降低肝脏复发的风险。(Ann Surg 2011; 254：114-118）
Background: After chemotherapy, complete clinical responses of colorectal liver metastases (CRLMs) increasingly occur, but these responses are rarely complete pathological responses. The management of patients with missing metastases, that is, CRLMs that disappear under chemotherapy are undetectable intraoperatively and finally left in place, continues to be controversial. The aim of this study was to assess the long-term outcome of patients with "missing CRLMs."Patients: Between 1999 and 2007, among 523 patients operated on for CRLMs, 96 missing CRLMs were observed and left in place in 27 originally unresectable patients. All of these patients received preoperative chemotherapy. Hepatic arterial infusion (HAI) of oxaliplatin combined with systemic 5-fluorouracil was administered in 23 patients, including 12 before hepatectomy and 11 after. Hepatic surgery was performed after a minimal interval of 3 months during which CRLMs had disappeared on imaging.Results: After a median follow-up of 55 months (24-137) after hepatic surgery, an intrahepatic recurrence was diagnosed in 14 (52%) patients, but the recurrence rate was significantly lower in patients who had received adjuvant HAI compared with the others (27% vs 83%, P = 0.006). Recurrences arose at the site of the missing CRLMs in 9 (33%) patients, but was associated in all cases with another recurrence in the liver. The 5-year overall survival rate of these 27 highly chemosensitive patients was 80%, and the 5-year disease-free survival rate was 23%.Conclusion: Highly chemosensitive patients, whose initially unresectable CRLMs become resectable because of missing CRLMs left in place, have a favorable long-term outcome. Missing CRLMs should not be longer, a contraindication to hepatic surgery. Use of postoperative HAI of oxaliplatin can help to reduce the risk of hepatic relapse. (Ann Surg 2011; 254: 114-118)