腹膜转移的结肠癌患者MDT诊治二例

本文描述了2例异时性腹膜转移的结肠癌病例的多学科诊治过程。1例多发转移,1例单发转移。这两例患者经MDT讨论后都首先采用了肿瘤减灭术联合腹腔热灌注化疗的治疗模式（cytoreductive surgery,CRS/hyperthermic intraperitoneal peroperative chemotherapy,HIPEC）,单发转移的患者目前获得了12个月的无病生存期（disease-free survival,DFS）,而多发转移的患者也获得了12个多月的总生存期（overall survival,OS）。目前发现与结直肠癌腹膜转移患者OS相关的因素包括肿瘤减灭术（CRS）完全程度和肿瘤累及的范围（腹膜转移癌指数）等。因此,对于结直肠癌的腹膜转移患者,评估病变范围极其重要,对于较局限的腹膜转移,多学科的综合诊治和积极的治疗手段能改善这部分患者的生存时间和生存质量。     

肝转移大肠癌的手术治疗与预后影响因素分析

目的探讨大肠癌肝转移的手术治疗方法及其预后影响因素。方法对33例肝转移大肠癌行原发灶根治术及肝转移灶切除术,分析手术效果及预后影响因素。结果患者术后1年、3年生存率分别为81.8%、51.5%。单个转移灶、分化程度高、无淋巴结转移、术前化疗以及异时转移时间超过6个月者预后较好。结论肝转移大肠癌患者的预预后影响因素主要为肝脏转移灶数量、分化程度、淋巴结转移、新辅助化疗以及异时转移时间。     

胃癌眼部转移临床特征分析

背景:胃癌常见远处转移部位为肝脏、肺、骨等,眼部转移相对罕见。目的:分析胃癌眼部转移的临床特征,提高对这一罕见转移的认识。方法:纳入2例在扬州市第一人民医院经手术确诊为胃癌眼部转移的病例,对其临床资料进行回顾性分析。结果:2例患者均为老年男性,单眼患病,原发肿瘤均为胃腺癌。2例患者均表现为右眼疼痛和视力障碍,CT检查发现右眼占位,眼底检查1例发现眼底窥不清,1例发现颞下方视网膜青灰色隆起。1例患者未行胃癌根治术,转移时间为胃癌确诊后2个月,另一例转移时间为胃癌根治术后10个月。2例患者均行眼部手术,术后病理为转移性腺癌,未行放化疗,于术后1年内死亡。结论:胃癌眼部转移中右侧转移较少见。本组2例患者出现眼部转移症状至死亡均不足一年,提示转移癌恶性程度高。其治疗宜采取眼部局部治疗联合全身化疗。     

基层医院开展腹腔镜下结直肠癌手术的临床应用(附10例报道)

目的探讨腹腔镜结直肠手术的临床应用价值。方法分析运用腹腔镜技术,按开放手术原则治疗结直肠癌10例的临床资料,其中右半结肠切除术2例,乙状结肠切除术2例,直肠癌行直肠前切除术(Dixon术)2例,Miles术3例。乙状结肠造瘘术1例。结果 10例手术均成功,1例因直肠中段癌合并肝左叶孤立转移癌,行Dixon术及开腹行肝左叶切除术。平均手术时间215 min,术中平均失血305 ml。术后肠蠕动恢复平均3.4 d,无术后出血、吻合口瘘等并发症。随访6～44月,2例因腹腔内广泛转移,于术后12个月及31个月死亡。1例肝脏转移瘤切除者于术后18个月因肝脓肿死亡,1例Miles术后28个月会阴部软组织种植转移,再次手术局部扩大切除随访12月无异常。结论腹腔镜结直肠手术安全可行,严格掌握手术适应证,熟练的腹腔镜手术技术和丰富的开腹结直肠手术经验是完成此类手术的关键     

中山医院结直肠癌MDT讨论治疗策略分析

目的分析结直肠癌多学科诊疗团队（MDT）讨论后制定的治疗策略。 方法回顾性分析2010年7月至2019年2月复旦大学附属中山医院进行MDT讨论的结直肠癌患者的临床资料,对MDT讨论结果进行统计分析。 结果结直肠癌MDT总计为1 953例结直肠癌患者进行4 535人次讨论制定个体化治疗方案。其中,553例患者肝转移灶和111例患者肺转移灶被认为可切除。另有261位最初不可切除的结直肠癌肝转移患者,在接受系统化疗联合分子靶向以及介入等综合治疗后,转化为可切除,建议接受肝转移灶切除手术。实际上总计772位结直肠癌患者接受肝转移灶切除,其中同时性肝转移患者有581例,而接受结直肠癌原发灶和肝转移灶同步切除的患者有248例。肝切除手术中仅有87例患者（11.3%）实施解剖性肝切除,绝大多数实施非解剖性肝切除。肝转移灶切除手术中联合射频消融的有62例（8.0%）。术后病理提示R1切除的有18位（2.3%）。 结论复杂结直肠癌病例推荐行MDT讨论。扩展手术适应证、应用二步肝切除术、联合射频消融等局部毁损治疗可以扩大肝转移灶手术的适应人群。初始无法手术切除的患者,如状况耐受,建议给予强烈的个体化转化治疗,争取转化后手术切除。     

肾上腺转移癌的诊断与治疗

目的总结肾上腺转移癌的诊断、治疗方法。方法回顾性分析2000～2011年收治的12例经病理检查证实的肾上腺转移癌患者的临床资料。结果术前B超检查诊断为肾上腺转移癌10例、肾上腺腺瘤1例、肾上腺增生1例,诊断正确率83.3%;术前CT检查诊断为肾上腺转移癌11例、肾上腺神经节细胞瘤1例,诊断正确率91.7%。8例行肾上腺及肿瘤切除术,术后生存0.5～11 a,平均33.2个月;3例行介入栓塞治疗,生存6～9个月,平均7.3个月;1例行放射治疗,生存6.5个月。手术切除肾上腺及肿瘤患者的生存时间明显长于介入栓塞治疗和放射治疗患者。结论 CT是诊断肾上腺转移癌的主要方法,手术切除是其主要治疗方法。     

直肠癌卵巢转移5例报道

直肠癌卵巢转移已成为造成妇女死亡的常见原因之一。一度曾认为卵巢很少发生转移癌,但通过资料的积累,现认为卵巢是一个很容易生长转移癌的器官[1]。不少原发于消化道的肿瘤,可首先转移至卵巢。病例：近3年本院共收治女性直肠癌患者43例,其中发生卵巢转移者5例,年龄43～56岁,均于行B超及CT检查时发现盆腔包块。1例患者直肠癌侵及腹膜并与周同组织粘连,两侧卵巢肿大（右侧6.5cm×7.5cm,左侧5cm×6cm）并与直肠癌周围组织粘连;行乙状结肠造口,双侧卵巢切除术;癌组织活检病理报告示粘液细胞癌,源十直肠。另4例患者行直肠癌根治术…     

结直肠癌肝转移的综合治疗策略

结直肠癌(colorectal cancer,CRC)是世界上常见的消化道肿瘤之一,约有50%的患者最终出现肝转移。对于发生肝转移的患者,若不经治疗,中位生存期仅为6.9个月,5年生存率为0。若肝脏转移灶行根治性手术,则中位生存期为35个月,5年生存率为30～50%,因此手术切除仍是结直肠癌肝转移治疗的首选。对于同时性肝转移的患者,若无肠道梗阻、穿孔、出血等症状,笔者倾向于同时性切除原发灶和转移灶,术中联合应用B超探查、微波、射频等新技术来提高切除率,降低复发率。而临床上只有少部分患者(10%～15%)可以行手术治疗。对于不可切除的肝转移灶,需通过多学科讨论,针对疾病某一时期,制定出详细的个体化综合性治疗方案,如术前新辅助化疗、联合靶向药物治疗、门静脉栓塞术的应用、局部治疗、放疗等,使得一些不可切除的病灶转化为可切除病灶。因此癌肿作为一项全身性疾病,单纯依靠一种治疗手段很难取得理想的效果,需要多学科的合作,通过对疾病的不同时期进行认识、讨论,以便找到针对某一时间段疾病的最佳治疗方法。同时术后需要定期复查及时发现复发和转移以及制定进一步治疗计划,从而提高患者的长期生存率及生活质量。     

胰腺肉瘤样癌2例报道

收集苏北人民医院收治的2例胰腺肉瘤样癌患者临床资料并随访6~12个月,同时检索相关文献。结果显示1例未能切除,术后未行放化疗,3个月后死亡。1例行手术切除,术后辅以静脉化疗,8个月后因多脏器转移死亡。胰腺肉瘤样癌少见,无特异性临床表现,恶性程度高,浸润性强,预后差,早期诊断和积极综合治疗可望获得较好的治疗效果、延长患者生存期。     

大肠癌患者骨髓转移癌细胞的检测及临床意义

作者以膜上皮抗原(epithelial membrane antigen,EMA)单克隆抗体为探针,对70例大肠癌患者进行了骨髓中癌细胞的检测,70例中查出阳性癌细胞者39例,阳性率为55.7%。骨髓内癌细胞的阳性率与肿瘤细胞分化程度、临床病理分期有关,腺癌、粘液癌、未分化癌骨髓内转移癌细胞的阳性率分别为47.9%、68.7%、83.3%,Duke's A 期、B 期、C 期、D 期的阳性率分别为23.1%、53.8%、69.6%和75.0%。单纯手术,手术 化疗以及手术 化疗 免疫治疗骨髓内转移癌细胞的转阴率分别为33.3%、42.9%和50.0%。本研究提示:骨髓内转移瘤细胞的检查可估计肿瘤的转移与复发,指导临床治疗,可做为大肠癌术后复查的一项常规检查。     

结肠癌伴可切除肝肺转移术前新辅助化疗一例

目前新辅助治疗对于转移性肠癌的治疗优势仍有争议。本例为初始可切除肝肺转移的肠癌患者实施了术前新辅助治疗，现将治疗过程中的一些经验和教训与大家分享。     

中国结直肠癌卵巢转移诊疗专家共识（2020版）

我国结直肠癌发病率和死亡率位于恶性肿瘤前五位。卵巢转移作为女性结直肠肿瘤患者相对少见的转移部位,其症状隐匿、进展迅速,对于常规化疗敏感性欠佳,临床治疗选择存在争议。因此,在中国医师协会结直肠肿瘤专业委员会的组织下,国内相关领域权威专家共同制定《中国结直肠癌卵巢转移诊疗专家共识》,以规范结直肠癌卵巢转移患者的诊疗流程,从而提高我国结直肠肿瘤的整体诊治水平,延长结直肠癌患者生存时间,改善生活质量。     

Hepatic resection of giant metastatic tumor from clear cell carcinoma of the ovary

All cancer patients, particularly those treated for colorectal cancer, should be monitored for the presence of liver metastases, but liver metastases from ovarian clear cell carcinoma are quite rare. We report a patient subjected to extended left hepatectomy due to a giant metastasis 5 years after surgical treatment for an ovarian neoplasm that was histopathologically diagnosed as clear cell carcinoma. A 58-year-old woman had undergone hysterectomy and bilateral salpingo-oophorectomy due to ovarian cancer (stage Ic). Four years and 8 months after the operation, a computed tomography (CT) scan demonstrated a giant tumor in the left lobe of the liver. The tumor compressed the inferior vena cava (IVC), but it was not clear whether it invaded the vessel. She received chemotherapy for 4 months; however, the tumor did not decrease in size. She was subsequently referred to our institution and was submitted to operation after it was confirmed that there were no distant metastases. After being subjected to an extended left hepatectomy and cholecystectomy, the patient recovered from the surgery without any complications. She has been carefully followed for 17 months and has presented no evidence of recurrence.     

Pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from transverse colon cancer

Pseudo-Meigs' syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female with a history of surgery for transverse colon cancer and peritoneal dissemination suffered from metachronous ovarian metastases during treatment with systemic chemotherapy. At first, neither ascites nor pleural effusion was observed, but she later complained of progressive abdominal distention and dyspnea caused by rapidly increasing ascites and pleural effusion and rapidly enlarging ovarian metastases. Abdominocenteses were repeated, and cytological examinations of the fluids were all negative for malignant cells. We suspected pseudo-Meigs' syndrome, and bilateral oophorectomies were performed after thorough informed consent. The patient's postoperative condition improved rapidly after surgery. We conclude that pseudo-Meigs' syndrome should be included in the differential diagnosis of massive or rapidly increasing ascites and pleural effusion associated with large or rapidly enlarging ovarian tumors.     

Pseudo-Meigs’ syndrome secondary to metachronous ovarian metastases from transverse colon cancer

Pseudo-Meigs’ syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs’ syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female with a history of surgery for transverse colon cancer and peritoneal dissemination suffered from metachronous ovarian metastases during treatment with systemic chemotherapy. At first, neither ascites nor pleural effusion was observed, but she later complained of progressive abdominal distention and dyspnea caused by rapidly increasing ascites and pleural effusion and rapidly enlarging ovarian metastases. Abdominocenteses were repeated, and cytological examinations of the fluids were all negative for malignant cells. We suspected pseudo-Meigs’ syndrome, and bilateral oophorectomies were performed after thorough informed consent. The patient’s postoperative condition improved rapidly after surgery. We conclude that pseudo-Meigs’ syndrome should be included in the differential diagnosis of massive or rapidly increasing ascites and pleural effusion associated with large or rapidly enlarging ovarian tumors.     

腹腔镜乙状结肠癌伴降结肠系膜旋转不良一例报道

降结肠系膜旋转不良（PDM）是由降结肠与腹膜后融合不全引起的，PDM通常无症状。然而，降结肠系膜旋转不良、乙状结肠向右侧与回盲部的先天粘连以及肠系膜下动脉的解剖变异等均可能会对结直肠癌的手术决策及难易度产生影响。我们报道一例乙状结肠癌伴肝转移瘤合并PDM的诊治，对其腹腔镜手术治疗的体会及注意要点加以阐述。     

Leiomyosarcoma of the sigmoid colon with multiple liver metastases and gastric cancer: a case report

ABSTRACT: BACKGROUND: Leiomyosarcoma (LMS) of the gastrointestinal tract is an extremely rare high-grade neoplasm with poor prognosis. For advanced LMS with distant metastasis, the decision as to the choice of the most appropriate therapeutic strategy, including chemotherapy and surgery, is difficult. Here, we present an unusual case of LMS of the sigmoid colon with liver metastases and gastric cancer. The survival of this patient was prolonged by a combined modality therapy involving chemotherapy and surgery. CASE PRESENTATION: A 66-year-old woman who had been diagnosed with advanced gastric cancer and multiple liver metastases was referred to our hospital. The initial treatment with docetaxel and S-1 considerably reduced both the gastric cancer and liver tumors; consequently we performed surgical resection. Pathological examination revealed that no viable tumor cells remained in the stomach and chemotherapy resulted in complete remission of the gastric cancer. The liver tumors were immunohistochemically diagnosed as LMS. A tumor of the sigmoid colon was subsequently discovered and the liver tumors were found to have recurred. The surgically resected sigmoid colon and liver tumors were all immunohistochemically diagnosed as LMS. These findings indicated that the multiple liver metastases arose from the LMS in the sigmoid colon, and that they were accompanied by advanced gastric cancer. We performed another surgical resection and administered chemotherapy to treat the recurring liver metastases. The patient survived for 4 years and 10 months after initial presentation at our hospital. CONCLUSION: Colonic LMS is rare and its joint occurrence with gastric cancer is extremely unusual. Although LMS is a high-grade neoplasm, a multimodal therapeutic approach can increase patient survival time even when multiple liver metastases are present.     

Clinical experience of Pseudo-Meigs＇ Syndrome due to colon cancer

We report a rare case of Pseudo-Meigs＇ Syndrome caused by ovarian metastasis from sigmoid colon cancer, which was accompanied by peritoneal dissemination. A 58-year-old female patient presented with massive right pleural effusion, ascites and a huge pelvic mass. Under the diagnosis of an advanced ovarian tumor, bilateral oophorectomy was performed and sigmoidectomy was also carried out after intraoperative diagnosis of peritoneal dissemination involving the sigmoid colon. How- ever, immunohistochemical staining revealed that the ovarian lesions were metastasis from the primary advanced colon cancer. Postoperatively, ascites and pleural effusion subsided, and the diagnosis of Pseudo-Meigs＇ Syndrome due to a metastatic ovarian tumor from colon cancer was determined. The patient is now undergoing a regimen of chemotherapy for colon cancer without recurrence of ascites or hydrothorax 10 mo after the surgery. Pseudo-Meigs＇ Syndrome due to a metastaticovarian tumor from colon cancer is rare but clinically important because long-term alleviation of symptoms can be achieved by surgical resection. This case report suggests that selected patients, even with peritoneal dissemination, may obtain palliation from surgical resection of metastatic ovarian tumors.     

ISOLATED INTRAMUSCULAR DISTANT METASTASIS AS AN INITIAL MANIFESTATION OF RECTAL CANCER

We describe a case of intramuscular metastasis in the thigh as an initial manifestation of rectal cancer, and review the previously reported 11 cases of skeletal distant metastasis from colorectal cancer. The patient was a 44‐year‐old man suffering from an increasingly painful mass in his left thigh. Magnetic resonance imaging showed an irregularly accentuated mass within the quadriceps femoral muscle, measuring 9 × 4 cm in size. The patient underwent an en bloc wide resection of the tumor, which was confirmed to be metastatic cancer which was diffusely positive for cytokeratin on immunohistochemistry. Further investigations revealed 3 cm‐sized primary rectal cancer with multiple liver metastases. Despite giving adjuvant chemotherapy, the patient died 6 months after the surgery. We should keep in mind that intramuscular metastasis may rarely occur as an initial manifestation of colorectal cancer when we encounter a patient with an undiagnosed intramuscular mass.