Radioimmunoguided surgery for patients with liver metastases secondary to colorectal cancer
Radioimmunoguided surgery for patients with liver metastases secondary to colorectal cancer
复制标题
DOI：
10.1007/bf02303827
复制
发表时间：
1998-10-01
影响因子：
3.7
通讯作者：
Martin, EW
中科院分区：
文献类型：
--
作者：
Bakalakos, EA;Young, DC;Martin, EW
背景：肝切除治疗转移性结直肠癌的5年生存率为30%。选择最有可能受益于切除术的患者具有挑战性。术前通过影像学技术，术中通过视觉、触觉和外科医生的直觉进行判断。确认所有肿瘤组织已被切除依赖于组织的外观和纹理，并通过常规组织学进行验证。作者的目的是评价（1）放射免疫导向手术（RIGS）改善转移性疾病术中检测的能力，以及（2）源自结直肠肝转移患者获得的信息的手术计划的任何改变。方法：1985年1月至1989年12月期间使用RIGS方法接受计划性肝切除术治疗结直肠癌的患者的图表和肿瘤登记数据1993年进行了审查。将这组患者与同期接受传统肝切除术治疗转移性结直肠癌的类似患者进行比较。在早期（1985-1990年）接受RIGS手术的患者注射肿瘤相关糖蛋白（TAG）抗体B72.3;在晚期（1990-1993年）接受RIGS手术的患者注射第二代抗TAG单克隆抗体CC 49。两种单克隆抗体均用碘化钠I 125标记。结果：74例计划性肝切除采用RIGS方法（I组），215例采用传统方法（II组）。两组的年龄和性别分布相似，发病率和死亡率也相似，围手术期总死亡率为1%。肝转移灶的分布和数量是相同的，虽然第一组包括更多的情况下，较小的转移灶和解剖切除的患者。II组中140例（65%）患者未发现肝外肿瘤，而I组中仅21例（28%）患者未检测到肝外疾病（P <0.001）。RIGS探查在74例病例中发现了12例（16%）额外的肿瘤：5例患者的胃肝韧带淋巴结（LN），1例患者的腹腔轴LN，6例患者的主动脉周围LN。这些发现改变了所有这些患者的手术计划，后6例患者避免切除，其他6例患者延长切除。结论：与传统探查相比，RIGS手术通过识别额外的转移性疾病（主要是淋巴结），从而改变了大量患者的切除计划。需要更多的研究来评估接受所有RIGS阳性组织切除的患者的任何显著生存优势。
Background: Hepatic resection for metastatic colorectal cancer offers a 5-year survival rate of 30%. Selection of patients who are most likely to benefit from excision is challenging. The judgment is made by radiographic techniques preoperatively and by sight and touch and the instinct of the surgeon intraoperatively. Confirmation that all tumor tissue has been excised relies on the appearance and texture of the tissue and is verified by routine histology. The authors' objective was to evaluate (1) the ability of radioimmunoguided surgery (RIGS) to improve the intraoperative detection of metastatic disease, and (2) any change in the operative plan originating from the information gained in patients with colorectal liver metastases.Methods: Charts and tumor registry data for patients who underwent planned liver resection for colorectal cancer using the RIGS method from January 1985 to December 1993 were reviewed. This group of patients was compared to a similar group that underwent traditional liver resection for metastatic colorectal cancer during the same period. Patients who had the RIGS procedure during the earlier part of the period (1985-1990), were injected with tumor-associated glycoprotein (TAG) antibody B72.3; those in the later period (1990-1993) were injected with the second-generation anti-TAG monoclonal antibody CC49. Both monoclonal antibodies were labeled with sodium iodide I 125. Both traditional and RIGS exploration were used to determine the extent of the malignant process and any change in operative plan.Results: Seventy-four cases of planned liver resection were performed with the RIGS method (group I), and 215 cases were performed with the traditional method (group II). Age and sex distribution were similar in both groups, as were morbidity and mortality, with an overall perioperative mortality of 1%. The distribution and number of metastatic lesions to the liver were the same, although group I included more cases with smaller metastatic lesions and more patients with anatomic resections. No extrahepatic tumor was found in 140 patients (65%) in group II, whereas there were only 21 patients (28%) in group I in whom no extrahepatic disease was detected (P < .001). RIGS exploration identified additional tumor in 12 (16%) of 74 cases: in the gastrohepatic ligament lymph nodes (LN) in five patients, in the celiac axis LN in one patient, and in the periaortic LN in six patients. These discoveries changed the operative plan for all of these patients, avoiding excision in the latter six patients and extending the resection in the other six.Conclusions: RIGS surgery provides an immediate and more accurate intraoperative staging system of patients with colorectal liver metastases than does traditional exploration by identifying additional metastatic disease, mainly to the lymph nodes, thus changing the plan of resection in a significant number of patients. More studies are needed to evaluate any significant survival advantage of patients who undergo removal of all RIGS-positive tissue.