Reverzný prístup k synchrónnym pečeňovým metastázam kolorektálneho karcinómu
Absolvovanie liečebného protokolu, strednodobé (trojročné) prežívanie a vzorec progresie ochorenia u 32 pacientov

Czech version

Authors: M. Straka ^1,2,4; M. Migrová ^1,2; R. Soumarová ^2,3; L. Burda ^1,2; I. Selingerová ⁵
Authors‘ workplace: Chirurgické oddělení Nemocnice Nový Jičín primář: MUDr. M. Škrovina, Ph. D. ¹; Komplexní onkologické centrum Nemocnice Nový Jičín vedoucí pracoviště: doc. MUDr. R. Soumarová, Ph. D., MBA ²; Oddělení radioterapie a onkologie Nemocnice Nový Jičín vedoucí pracoviště: doc. MUDr. R. Soumarová, Ph. D., MBA ³; Vzdělávací a výzkumný institut AGEL o. p. s., Prostějov ředitelka: Ing. Mgr. K. Murtingerová ⁴; Přírodovědecká fakulta Masarykovy univerzity Brno, Ústav matematiky a statistiky a MOÚ Brno ředitel: prof. RNDr. J. Slovák, Dr. Sc. ⁵
Published in: Rozhl. Chir., 2016, roč. 95, č. 7, s. 280-286.
Category: Original articles

Overview

Introduction:
Reverse, liver-first strategy is an alternative for patients with complicated liver metastases where disease progression would prove inoperable, or for patients with locally advanced pelvic disease where postoperative complications after primary tumour resection may lead to delayed treatment of metastatic disease.

Methods:
Retrospective unicenter analysis of 32 patients approached liver-first approach between 2011 and 2015. During this period reverse strategy was considered a preferred approach for all initially or potentially resectable synchronous colorectal liver metastases based on multidisciplinary team consensus.

Results:
26 patients (81.3%) completed their surgical plan (hepatectomy and primary tumour resection) but only 16 (50%) completed their oncosurgical plan (hepatectomy, primary tumour resection and full dose and length of perioperative or adjuvant systemic (bio)chemotherapy). Median overall survival was 50.5 months with the survival rate of 83.7% at 3 years. 20 patients (62.5%) progressed during the follow-up with median time to progression of 21.6 months. The liver was the most common site of recurrent disease followed by the lungs (65% and 20% of all recurrences, respectively).

Conclusion:
While reverse strategy may allow complete tumour removal in the majority of patients, only half of them complete their oncosurgical plan even with the liver-first approach. The most problematic aspect of the liver-first strategy is the timing and length of perioperative (bio)chemotherapy. When deciding on preoperative chemotherapy in up-front resectable lesions one should take into account the risk of disease progression while on chemotherapy as well as the risks of complete radiologic response.

Key words:
colorectal carcinoma − reverse strategy − liver-first approach − liver metastases

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