Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases
Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases
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DOI：
10.1097/sla.0b013e31815ed693
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发表时间：
2008-03-01
影响因子：
9
通讯作者：
Fong, Yuman
中科院分区：
文献类型：
--
作者：
Covey, Anne M.;Brown, Karen T.;Fong, Yuman
目的：1)确定结肠癌同期化疗患者行门静脉栓塞术(PVE)后，未来肝残留量是否增加；2)确定扩大肝切除术后的恢复情况。目的：新辅助化疗后肝切除是治疗结直肠癌转移瘤的常用治疗策略。然而，这种化疗可能会导致脂肪变性、肝脏损伤，并损害肝脏的再生和恢复。本研究旨在探讨PVE能否在新辅助治疗中应用，以促进未来残肝的生长，改善术后恢复。方法：1999年9月至2004年9月，100例结直肠癌肝转移患者接受PVE，为扩大肝切除术做准备，其中43例在新辅助化疗期间进行了栓塞术。通过计算机断层扫描体积分析检查肝脏生长情况。结果：在PVE后中位等待30+/-2天后，接受新辅助化疗的患者的对侧(非栓塞组)肝脏增长中位数为22%+/-3%，而不接受化疗的患者为26%+/-3%(P=NS)。患有艾滋病的患者数量
Objectives: The objectives of this study are 1) to determine whether the future liver remnant will grow after portal vein embolization (PVE) in patients with colon cancer on concurrent chemotherapy and 2) to determine whether recovery after extended hepatectomy is improved after PVE.Purpose: Neoadjuvant chemotherapy followed by hepatic resection is an increasingly used therapeutic strategy for curative treatment for colorectal metastases. However, such chemotherapy may result in steatosis, liver damage, and compromised liver regeneration and recovery. This study aims to deten-nine whether PVE can be used during neoadjuvant therapy to enhance growth of future residual liver and to improve postoperative recovery.Methods: From September 1999 to September 2004, 100 patients with colorectal metastases to the liver were subjected to PVE as preparation for extended hepatic resection, 43 of whom were embolized during neoadjuvant chemotherapy. Liver growth was examined by computed tomography volumetric analysis. Clinical outcomes of the 71 patients subsequently resected were compared with 100 consecutive patients subjected to extended resection without PVE (controls).Results: After a median wait of 30 +/- 2 days after PVE, patients on neoadjuvant chemotherapy experienced a median contralateral (nonembolized) liver growth of 22% +/- 3% compared with 26% +/- 3% for those without chemotherapy (P = NS). The number of patients with