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1.
Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases 总被引:12,自引:0,他引:12
Fernandez FG Ritter J Goodwin JW Linehan DC Hawkins WG Strasberg SM 《Journal of the American College of Surgeons》2005,200(6):845-853
BACKGROUND: The objective was to evaluate the effect of preoperative administration of newer chemotherapeutic agents (irinotecan and oxaliplatin) on development of steatohepatitis, which could limit surgical options. STUDY DESIGN: Thirty-seven patients were referred for resection of hepatic colorectal metastases. Thirteen patients received no neoadjuvant therapy (NO CHEMO group); 10 received neoadjuvant 5-fluorouracil only (5-FU group), and 14 received neoadjuvant irinotecan (n = 12), or oxaliplatin, or both (n = 4), in conjunction with 5-FU (IRI-OXALI group). Specimens were graded for the presence of nonalcoholic steatohepatitis (NASH) according to established criteria. Specimens were also evaluated by a nine-criteria liver injury score (LIS). RESULTS: Mean biopsy scores were: NO CHEMO: NASH, 1.2, LIS, 5.2; 5-FU only: NASH, 1.1, LIS 5.7; and IRI-OXALI: NASH, 1.9, LIS, 9.4. Biopsy scores were significantly worse for IRI-OXALI compared with NO CHEMO or 5-FU only for NASH score, p = 0.003, and close to significantly worse for LIS score, p = 0.057. A multivariate analysis showed that both being in the IRI-OXALI group and body mass index were independent risk factors for developing this type of steatohepatitis. CONCLUSIONS: Severe steatohepatitis can be associated with preoperative administration of irinotecan or oxaliplatin, especially in the obese. It can affect the ability to perform large liver resections. Consideration should be given to performing resections before commencing these agents and to obtaining preoperative biopsy in those who have received these agents. 相似文献
2.
Zorzi D Laurent A Pawlik TM Lauwers GY Vauthey JN Abdalla EK 《The British journal of surgery》2007,94(3):274-286
BACKGROUND: Preoperative systemic chemotherapy is increasingly used in patients who undergo hepatic resection for colorectal liver metastases (CLM). Although chemotherapy-related hepatic injury has been reported, the incidence and the effect of such injury on patient outcome remain ill defined. METHODS: A systematic review of relevant studies published before May 2006 was performed. Studies that reported on liver injury associated with preoperative chemotherapy for CLM were identified and data on chemotherapy-specific liver injury and patient outcome following hepatic resection were synthesized and tabulated. RESULTS: Hepatic steatosis, a mild manifestation of non-alcoholic fatty liver disease (NAFLD), may occur after treatment with 5-fluorouracil and is associated with increased postoperative morbidity. Non-alcoholic steatohepatitis, a serious complication of NAFLD that includes inflammation and hepatocyte damage, can occur after treatment with irinotecan, especially in obese patients. Irinotecan-associated steatohepatitis can affect hepatic reserve and increase morbidity and mortality after hepatectomy. Hepatic sinusoidal obstruction syndrome can occur in patients treated with oxaliplatin, but does not appear to be associated with an increased risk of perioperative death. CONCLUSION: Preoperative chemotherapy for CLM induces regimen-specific hepatic changes that can affect patient outcome. Both response rate and toxicity should be considered when selecting preoperative chemotherapy in patients with CLM. 相似文献
3.
Srinevas K. Reddy Gloria Broadwater Donna Niedzwiecki Andrew S. Barbas Herbert I. Hurwitz Johanna C. Bendell Michael A. Morse Bryan M. Clary 《Journal of gastrointestinal surgery》2009,13(1):74-84
Background Few studies identifying variables associated with prognosis after resection of colorectal liver metastases (CLM) account for
treatment with multiagent chemotherapy (fluoropyrmidines with irinotecan, oxaliplatin, bevacizumab, and/or cetuximab). The
objective of this retrospective study was to determine the effect of multiagent chemotherapy on long-term survival after resection
of CLM.
Methods Demographics, clinicopathologic tumor characteristics, treatments, and long-term outcomes were reviewed.
Results From 1996 to 2006, 230 patients underwent resection of CLM. Treatment strategies before and after resection included fluoropyrimidine
monotherapy (n = 34 and n = 39), multiagent chemotherapy (n = 81 and n = 73), and observation (n = 115 and n = 118). Prehepatectomy treatment strategy was not associated with overall survival. Actuarial 4-year survival was 63%, 39%,
and 40% for patients treated with multiagent chemotherapy, fluoropyrimidine monotherapy, and observation after hepatectomy,
p = 0.06. Posthepatectomy multiagent chemotherapy (p = 0.04, HR 0.52 [0.27–1.03]), duration of posthepatectomy chemotherapy treatment of 2 months or longer (p = 0.05, HR 0.49 [0.25–0.99]), carcino-embryonic antigen level >10 ng/mL (p = 0.03, HR 2.09, 95% CI [1.32–3.32]), and node positive primary tumor (p = 0.002, HR 1.79 [1.06–3.02]) were associated with overall survival in multivariate analysis.
Conclusions The association of posthepatectomy multiagent chemotherapy with overall survival in this retrospective study indicates the
need for prospective randomized trials comparing multiagent chemotherapy and fluoropyrimidine monotherapy for CLM. 相似文献
4.
Chemotherapy is being administered to an increasing number of patients with colorectal liver metastases (CRLM), whether they have resectable disease or not. Although this may be appropriate to downstage patients with unresectable disease, and offers theoretical advantages to those who have resectable disease, there is a price to be paid in the development of chemotherapy-induced hepatic injuries (CIHI). These include chemotherapy-associated fatty liver diseases and sinusoidal injuries. The main chemotherapeutic agents currently used in the adjuvant setting for colorectal carcinoma, and the neoadjuvant treatment of CRLM include 5-flurouracil, oxaliplatin and irinotecan, and while there are non-specific and overlapping injury profiles, oxaliplatin does appear to be primarily associated with sinusoidal injury and irinotecan with steatohepatitis. In this review, the rationale for administering chemotherapy to patients with CRLM is presented, and the problems this brings are outlined. The specific injury patterns will be detailed, as well as the data correlating specific chemotherapy regimens to these injury patterns. Finally, the clinical outcomes of patients with CRLM who undergo neoadjuvant chemotherapy followed by hepatic resection will be considered. The need for methods to identify patients at risk of CIHI and to recognize established CIHI prior to surgery will be emphasized. 相似文献
5.
Wicherts DA de Haas RJ Sebagh M Ciacio O Lévi F Paule B Giacchetti S Guettier C Azoulay D Castaing D Adam R 《Annals of surgical oncology》2011,18(3):659-669
Background
Regenerative nodular hyperplasia (RNH) represents the end-stage of vascular lesions of the liver induced by chemotherapy. The goal was to evaluate its incidence and impact on the outcome of patients resected for colorectal liver metastases (CLM).Methods
Patients who underwent hepatectomy for CLM after six cycles or more of first-line chemotherapy, between January 1990 and November 2006, were included. Detailed histopathologic analysis of the nontumoral liver was performed according to a standard format.Results
From a cohort of 856 resected patients at our institution, 771 (90%) received preoperative chemotherapy. Of these, 146 fulfilled the selection criteria and were included: 24 (16%) received 5-fluorouracil (5-FU) and leucovorin (LV) alone, 92 (63%) had 5-FU/LV and oxaliplatin, 18 (12%) had 5-FU/LV and irinotecan, and 12 (8%) were treated by 5-FU/LV, oxaliplatin, and irinotecan. RNH occurred in 22 of 146 patients (15%). Twenty of these patients (91%) received oxaliplatin, of whom six (30%) had chronomodulated therapy. Patients treated by oxaliplatin more often had RNH compared with oxaliplatin-naïve patients (22 vs. 4%). Although operative mortality was nil, the presence of RNH was associated with increased postoperative hepatic morbidity (50 vs. 29%). Elevated preoperative gamma-glutamyltransferase (GGT) (>80 U/L; >1N) and total bilirubin levels (>15 μmol/L; >1N) were independent predictors of RNH.Conclusions
Patients with CLM who receive preoperative oxaliplatin have an increased risk of RNH and associated postoperative morbidity. Increased serum GGT and bilirubin are useful markers to predict the presence of RNH. 相似文献6.
Yun Shin Chun Jean-Nicolas Vauthey Dario Ribero Matteo Donadon John T. Mullen Cathy Eng David C. Madoff David Z. Chang Linus Ho Scott Kopetz Steven H. Wei Steven A. Curley Eddie K. Abdalla 《Journal of gastrointestinal surgery》2007,11(11):1498-1505
Background
Two-stage hepatectomy has been proposed for patients with bilateral colorectal liver metastases (CLM). The aim of this study
was to compare the outcome of patients with CLM treated with preoperative chemotherapy followed by one- or two-stage hepatectomy.
Methods
From a prospective database, 214 consecutive patients who received preoperative systemic chemotherapy (fluoropyrimidine with
irinotecan or oxaliplatin) followed by planned one- or two-stage hepatectomy were retrospectively analyzed (1998–2006). In
patients undergoing two-stage procedures, minor hepatectomy (wedge or segmental resection[s]) was systematically performed
before major (more than three segments), second-stage hepatectomy. Preoperative portal vein embolization (PVE) was performed
if indicated.
Results
One- (group I) and two-stage(group II) hepatectomies were performed in 184 and 21 patients, respectively. Median number of
metastases in groups I and II were two (range 1–20) and seven (range 2–20). All patients in group II had bilateral disease
vs 39% in group I. Major hepatectomy was performed in all patients in group II and 79% in group I. PVE was performed in 18
group I and 12 group II patients without increase in morbidity. For group I, group II first stage, and group II second stage,
respectively, morbidity (24%, 24%, 43%), median hospital stay (7 days, 6 days, 6.5 days) and 30 days postoperative mortality
(2%, 0%, 0%) were not significantly different (P = NS). Median follow-up was 25 months; median survival has not been reached. One- and 3-year overall and disease-free survival
rates from the time of hepatic resection were 95% and 75%, 63% and 39%, respectively in group I; 95% and 86%, 70% and 51%,
respectively in group II (P = NS).
Conclusions
Two-stage hepatectomy with preoperative chemotherapy results in comparable morbidity and survival rates as one-stage hepatectomy.
This approach enables selection and treatment of patients with multiple, bilateral CLM who will benefit from aggressive surgery
with good outcomes.
Presented at the Society for Surgery of the Alimentary Tract 48th Annual Meeting, May 2007, Washington, DC. 相似文献
7.
Nir Lubezky Ur Metser Ravit Geva Richard Nakache Einat Shmueli Joseph M. Klausner Einat Even-Sapir Arie Figer Menahem Ben-Haim 《Journal of gastrointestinal surgery》2007,11(4):472-478
Background Recent data confirmed the importance of 18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in the selection of patients with colorectal hepatic metastases for surgery.
Neoadjuvant chemotherapy before hepatic resection in selected cases may improve outcome. The influence of chemotherapy on
the sensitivity of FDG-PET and CT in detecting liver metastases is not known.
Methods Patients were assigned to either neoadjuvant treatment or immediate hepatic resection according to resectability, risk of
recurrence, extrahepatic disease, and patient preference. Two-thirds of them underwent FDG-PET/CT before chemotherapy; all
underwent preoperative contrast-enhanced CT and FDG-PET/CT. Those without extensive extrahepatic disease underwent open exploration
and resection of all the metastases according to original imaging findings. Operative and pathological findings were compared
to imaging results.
Results Twenty-seven patients (33 lesions) underwent immediate hepatic resection (group 1), and 48 patients (122 lesions) received
preoperative neoadjuvant chemotherapy (group 2). Sensitivity of FDG-PET and CT in detecting colorectal (CR) metastases was
significantly higher in group 1 than in group 2 (FDG-PET: 93.3 vs 49%, P < 0.0001; CT: 87.5 vs 65.3, P = 0.038). CT had a higher sensitivity than FDG-PET in detecting CR metastases following neoadjuvant therapy (65.3 vs 49%,
P < 0.0001). Sensitivity of FDG-PET, but not of CT, was lower in group 2 patients whose chemotherapy included bevacizumab compared
to patients who did not receive bevacizumab (39 vs 59%, P = 0.068).
Conclusions FDG-PET/CT sensitivity is lowered by neoadjuvant chemotherapy. CT is more sensitive than FDG-PET in detecting CR metastases
following neoadjuvant therapy. Surgical decision-making requires information from multiple imaging modalities and pretreatment
findings. Baseline FDG-PET and CT before neoadjuvant therapy are mandatory.
The abstract was presented before the 58th Cancer Symposium of the Society of Surgical Oncology, Atlanta, GA, USA, 2005, and
before the 2005 Congress of the American Hepato-Pancreato-Biliary Association, Fort-Lauderdale, FL, USA. 相似文献
8.
Qi-Ying Lu Ai-Lian Zhao Wei Deng Zhong-Wu Li Lin Shen 《World journal of gastrointestinal surgery》2013,5(3):30-36
AIM: To assess the effects of preoperative treatment on the hepatic histology of non-tumoral liver and the postoperative outcome.METHODS: One hundred and six patients underwent hepatic resection for colorectal metastases between 1999 and 2009. The surgical specimens were reviewed with established criteria for diagnosis and grading of pathological hepatic injury. The impact of preoperative therapy on liver injury and postoperative outcome was analyzed.RESULTS: Fifty-three patients (50%) received surgery alone, whereas 42 patients (39.6%) received neoadjuvant chemotherapy and 11 (10.4%) patients received preoperative hepatic artery infusion (HAI). Chemotherapy included oxaliplatin-based regimens (31.1%) and irinotecan-based regimens (8.5%). On histopathological analysis, 16 patients (15.1%) had steatosis, 31 (29.2%) had sinusoidal dilation and 20 patients (18.9%) had steatohepatitis. Preoperative oxaliplatin was associated with sinusoidal dilation compared with surgery alone (42.4% vs 20.8%, P = 0.03); however, the perioperative complication rate was not significantly different between the oxaliplatin group and surgery group (27.3% vs 13.2%, P = 0.1). HAI was associated with more steatosis, sinusoidal dilation and steatohepatitis than the surgery group, with higher perioperative morbidity (36.4% vs 13.2%, P = 0.06) and mortality (9.1% vs 0% P = 0.02).CONCLUSION: Preoperative oxaliplatin was associated with sinusoidal dilation compared with surgery alone. However, the preoperative oxaliplatin had no significant impact on perioperative outcomes. HAI can cause pathological changes and tends to increase perioperative morbidity and mortality. 相似文献
9.
Michelle L. DeOliveira Timothy M. Pawlik Ana L. Gleisner Lia Assumpcaom Gaspar J. Lopes-Filho Michael A. Choti 《Journal of gastrointestinal surgery》2007,11(8):970-976
Survival after resection of colorectal liver metastases has traditionally been associated with clinicopathologic factors.
We sought to investigate whether echogenicity of colorectal liver metastasis as assessed by intraoperative ultrasound (IOUS)
was a prognostic factor after hepatic resection. Prospective data on tumor IOUS appearance were collected in 84 patients who
underwent hepatic resection for colorectal liver metastasis. Images were digitally recorded, blindly reviewed, and scored
for echogenicity (hypo-, iso-, or hyperechoic). The median tumor number was 1 and the median tumor size was 5.0 cm. At the
time of surgery, the IOUS appearance of the colorectal liver metastases were hypoechoic in 35 (41.7%) patients, isoechoic
in 37 (44.0%) patients, and hyperechoic in 12 (14.3%) patients. Traditional clinicopathologic prognostic factors were similarly
distributed among the three echogenicity groups (all p > 0.05). Patients with a hypoechoic lesion had a significantly shorter median survival (30.2 months) compared with patients
who had either an isoechoic (53.2 months) or hyperechoic (42.3 months) lesion (p = 0.005). The 5-year survival after hepatic resection of colorectal liver metastasis was also associated with the echogenic
appearance of the lesion (hypoechoic 14.4 vs isoechoic 37.4 vs hyperechoic 46.2%) (p < 0.05). Intraoperative ultrasound echogenicity should be considered a prognostic factor after hepatic resection of metastatic
colorectal cancer.
This study was presented at the 47th annual meeting of The Society for Surgery of the Alimentary Tract, Los Angeles, CA, USA,
22 May 2006. 相似文献
10.
Tamara L. Znajda M.D. F.R.C.S.C. Shinichi Hayashi M.D. Peter J. Horton M.D. F.R.C.S. John B. Martinie M.D. F.A.C.S. Prosanto Chaudhury M.D. F.R.C.S.C. Victoria A. Marcus M.D. F.R.C.P. Jeremy R. Jass M.D. F.R.C.P. Peter Metrakos M.D. F.R.C.S.C. 《Journal of gastrointestinal surgery》2006,10(4):483-489
Accepted management for colorectal cancer (CRC) involves resection of the primary neoplasm and chemotherapy; the debate continues
over the most beneficial order of these components. Preoperative chemotherapy aimed at liver metastases may result in complete
pathologic response and replacement of the malignancy with scar. The McGill University liver diseases database was retrospectively
reviewed. Fortyone patients receiving treatment between December 2003 and August 2004 were identified, their medical records
examined, and liver histology reviewed. The histology of the remnants was linked to the appearance of the lesions on preresection
imaging and to the primary colorectal neoplasms. Twenty-seven of the 41 patients (66%) received preoperative chemotherapy
(oxaliplatin or irinotecan). Features of the primary neoplasm that predicted resolution of the metastases were absence of
tumor budding (P = 0.04), absence of a diffusely infiltrative tumor margin (P = 0.02), and loss of expression of the DNA repair gene O6-methylguanine-DNA methyltransferase (P = 0.08). Oxaliplatin and irinotecan demonstrate beneficial effects in treating hepatic colorectal metastases and should be
considered in such patients before resection. We propose the acronym RUMP to denote the remnants of uncertain malignant potential
remaining. Further investigation is required to determine any correlation between the drug received and the resulting lesion.
Presented at the 2005 American Hepato-Pancreato-Biliary Association Congress, Hollywood, Florida, April 14–17, 2005. 相似文献
11.
Radiofrequency Ablation vs. Resection for Hepatic Colorectal Metastasis: Therapeutically Equivalent?
Nathaniel P. Reuter Charles E. Woodall Charles R. Scoggins Kelly M. McMasters Robert C. G. Martin 《Journal of gastrointestinal surgery》2009,13(3):486-491
Introduction The role of ablation for hepatic colorectal metastases (HCM) continues to evolve as ablation technology changes and systemic
chemotherapy improves. Our aim was to evaluate the therapeutic efficacy of radiofrequency ablation (RFA) of HCM compared to
surgical resection.
Methods A retrospective review of our 1,105 patient prospective hepatic database from August 1995 to July 2007 identified 192 patients
with only hepatic resection or only ablation for HCM.
Results Patients who underwent RFA were similar to resection patients based on a similar Fong score (1.8 vs. 2.1 p = 0.28), presence of extrahepatic disease (15% vs. 9% p = 0.19), mean number of hepatic lesions (2.8 vs. 2.1 p = 0.14), and prior chemotherapy (67% vs. 60% p = 0.33). Median time to recurrence was shorter with ablation than resection (12.2 vs. 31.1 months; p < 0.001). Recurrence at the ablation–resection site was more common with ablation than resection occurring 17% vs. 2% (p ≤ 0.001) of the time, respectively. Distant recurrence in the liver was also more common with ablation occurring in 33% of
patients vs. 14% for resection (p = 0.002).
Conclusions Surgical resection is associated with a lower chance of recurrence and a longer disease-free interval than RFA and should
remain the treatment of choice in resectable HCM. 相似文献
12.
Survival of Patients with Synchronous and Metachronous Colorectal Liver Metastases—is there a Difference? 总被引:1,自引:0,他引:1
Maximilian Bockhorn Andreja Frilling Nils R. Frühauf Jan Neuhaus Ernesto Molmenti Tanja Trarbach Massimo Malagó Hauke Lang Christoph E. Broelsch 《Journal of gastrointestinal surgery》2008,12(8):1399-1405
Background The aim of this study was to compare outcomes in patients with synchronous and metachronous colorectal liver metastases, with
special emphasis on prognostic determinants.
Study design We analyzed prospectively collected data on 101 patients with synchronous metastases (group A) who were treated surgically
during the time period from April 1998 to December 2006 in regard to overall and disease-free survival, impact of chemotherapy,
as well as several serum parameters. A group of patients with metachronous colorectal liver metastases (group B) was considered
for baseline comparison.
Results Twenty-three patients in group A received only an explorative laparotomy. Surgical treatment included right hepatectomy (n = 7), left hepatectomy (n = 5), right trisectionectomy (n = 10), left trisectionectomy (n = 1), left lateral resection (n = 11), and sectionectomy (n = 44). Thirty-day mortality was 3%. Morbidity was observed in 10% of the patients. One-, 3-, and 5-year overall survival
rates for synchronous metastases were 86%, 68%, and 47%, respectively. The corresponding rates for metachronous metastases
were 94%, 68%, and 39% (p > 0.05). Disease free survival was 74%, 42%, and 33% in group A versus 84%, 62%, and 13% in group B (p = 0.28). There was no difference in survival between patients receiving neoadjuvant chemotherapy and no chemotherapy (p > 0.05). Out of all serum parameters, carcinoembryonic antigen levels were a negative predictor for overall and disease-free
survival only.
Conclusions Patients with synchronous colorectal liver metastases had a similar 5-year overall and disease-free survival, which corresponds
to patients with metachronous metastases. The impact of neoadjuvant chemotherapy in patients with synchronous metastases needs
to be further clarified. 相似文献
13.
Preoperative Chemotherapy and the Outcome of Liver Resection for Colorectal Metastases 总被引:1,自引:1,他引:0
Hewes JC Dighe S Morris RW Hutchins RR Bhattacharya S Davidson BR 《World journal of surgery》2007,31(2):353-364
Background Neoadjuvant systemic chemotherapy is being increasingly used prior to liver resection for colorectal metastases. Oxaliplatin
has been implicated in causing structural changes to the liver parenchyma, and such changes may increase the morbidity and
mortality of surgery.
Patients and Methods A retrospective study was undertaken of 101 consecutive patients who had undergone liver resection for colorectal metastases
in two HPB centers. Preoperative demographic and premorbid data were gathered along with liver function tests and tumor markers.
A subjective assessment of the surgical procedure was noted, and in-hospital morbidity and mortality were calculated. The
effect of preoperative chemotherapy on short-term and long-term outcome was analyzed, and actuarial 1 and 3 year survival
was determined.
Results Patients who received neoadjuvant chemotherapy had a higher number of metastases (median 2, range 1–8 versus median 1, range
1–5; P = 0.019) and more had synchronous tumors (24 patients versus 8; P < 0.001). Overall morbidity was 37% and hospital mortality was 3.9%. Operative and in-hospital outcome was not influenced
by chemotherapy. Long-term survival was worse in patients who had received preoperative chemotherapy (actuarial 3-year survival
62% versus 80%; P = 0.04).
Conclusions This study shows no evidence that neoadjuvant chemotherapy, and in particular oxaliplatin, increases the risk associated with
liver resection for colorectal metastases. Long-term outcome is reduced in patients receiving preoperative chemotherapy, although
they have more advanced disease. 相似文献
14.
Boige V Malka D Elias D Castaing M De Baere T Goere D Dromain C Pocard M Ducreux M 《Annals of surgical oncology》2008,15(1):219-226
Background We have previously shown promising activity of hepatic arterial infusion (HAI) oxaliplatin combined with intravenous (IV)
5-fluorouracil (5-FU) and leucovorin (LV) as first-line chemotherapy in patients with colorectal liver metastases (CRLM) (intent-to-treat
[ITT] objective response rate [ORR], 64%; secondary resection rate, 18%; overall survival [OS], 27 months). Whether this regimen
could be beneficial after systemic chemotherapy failure is unknown.
Methods Patients with unresectable CRLM and history of systemic chemotherapy failure were treated bimonthly with HAI oxaliplatin (100
mg/m2 2 hours) combined with IV LV and IV bolus and infusional 5FU (modified LV5FU2 regimen).
Results Forty-four consecutive patients (median age 56 years; median number of prior systemic chemotherapy regimens, 2 range 1–5)
were included, of whom 43 (98%) had previously received oxaliplatin (n = 34), irinotecan (n = 37), or both (n = 28). Patients received a median of nine cycles of HAI oxaliplatin and IV modified LV5FU2 (range 0–25). Toxicity included
grade 3–4 neutropenia (43%), grade 2–3 neuropathy (43%), and grade 3–4 abdominal pain (14%). We observed 24 partial ORs (62%)
among the 39 assessable patients (ITT ORR, 55%; 95% CI, 40–69%), including 17, 12, and 12 patients who had failed to respond
to prior systemic chemotherapy with FOLFIRI, FOLFOX, or both, respectively. Tumor response allowed further R0 surgical resection
(n = 7) or radiofrequency ablation (n = 1) of initially unresectable CRLM in eight patients (18%). Median progression-free survival and OS were 7 and 16 months,
respectively.
Conclusions HAI oxaliplatin and IV LV5FU2 is feasible, safe, and shows promising activity after systemic chemotherapy failure, allowing
surgical resection of initially unresectable CRLM in 18% of patients. 相似文献
15.
Gómez-Ramírez J Martín-Pérez E Amat CG Sanz IG Bermejo E Rodríguez A Larrañaga E 《Cirugía espa?ola》2010,88(6):404-412
IntroductionThe aim of the study was to evaluate the relationship between the pre-surgical administration of a chemotherapy regime based on irinotecan or oxaliplatin and the development of non-alcoholic fatty liver disease (NAFLD) or sinusoidal obstruction syndrome (SOS), and the influence of these histological changes on the outcome of patients after surgical intervention.Patients and methodA prospective study which included 45 patients surgically intervened due to colorectal cancer liver metastases between May 2005 and July 2009. Demographic data and the variables before during and after the operation were collected. A specimen of the resection was obtained for histological analysis following the classification parameters of the NAFLD (NASH index) and SOS scale.ResultsNeoadjuvant chemotherapy was given before the resection in 22 cases (study group) and 23 patients made up the control group (no chemotherapy). Borderline or diagnostic steatohepatitis was observed in 4 of the 7 patients (57.2%) who were given preoperative irinotecan (P=0.001). Seven of the 15 patients (46.7%) treated with oxaliplatin developed a moderate or severe SOS (P=0.002). There were no differences in morbidity or mortality associated to the NAFLD grade, but there was a higher rate of liver complications and longer mean hospital stay in patients with moderate/severe SOS (P=0.004 and P=0.021, respectively).ConclusionsTreatment with irinotecan was significantly associated with an increase in the incidence of steatohepatitis, but did not increase the morbidity or mortality. Patients treated with oxaliplatin had a higher incidence of SOS, an increase in liver complications and a longer mean hospital stay. 相似文献
16.
Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy 总被引:6,自引:2,他引:6
Alexander A. Parikh M.D. Bernhard Gentner M.D. Tsung-Teh Wu M.D. Ph.D. Steven A. Curley M.D. Lee M. Ellis M.D. Jean-Nicolas Vauthey M.D. 《Journal of gastrointestinal surgery》2003,7(8):1082-1088
Systemic chemotherapy is used increasingly prior to resection of hepatic colorectal metastases. Previous reports have indicated
an increased risk of perioperative complications associated with the use of systemic chemotherapy prior to resection. The
purpose of this study was to investigate perioperative complications in patients receiving neoadjuvant systemic chemotherapy
consisting of 5-fluorouracil (5-FU) and leucovorin (LV) with or without CPT-11 within 6 months of major liver resection. A
retrospective review of 108 patients undergoing major liver resection for colorectal metastases with curative intent from
1997 to 2002 was performed. Patient and tumor characteristics, perioperative parameters, and morbidity and mortality were
measured. Forty-seven patients (44%) received no chemotherapy, 27 patients (25%) received systemic 5-FU/LV, and 34 (31%) received
systemic 5-FU/LV/CPT-11. A significantly higher number of patients in the group treated with preoperative 5-FU/LV plus CPT-11
had multiple tumors. Patients in this group also tended to have smaller tumors, fewer complications, and a higher R0 margin
resection rate, but these findings were not statistically significant. Median blood loss and length of hospital stay were
also not significantly different. There were no perioperative deaths. We conclude that the use of fluoropyrimidine-based chemotherapy
and CPT-11 prior to major liver resection is not associated with increased morbidity or mortality. It may therefore provide
a better therapeutic option, particularly in patients with multiple colorectal metastases.
Presented as an abstract at the Fourth Biennial Congress of the American Hepato-Pancreato-Biliary Association (AHPBA), Miami
Beach, Florida, February 27–March 2, 2003. 相似文献
17.
THE SITUATION: With around 35.000 new cases per year and a 40% mortality rate, colorectal cancer is a real problem of health care in France. Chemotherapy for metastatic disease has completely changed during the ten last years with the emergence of promising new drugs such as oxaliplatin and irinotecan. Oral 5-FU prodrugs have also shown an interesting efficacy in this setting. RESULTS: Showed increased response rate, progression free survival with both drugs, and overall survival, only with the irinotecan-based regimen. Moreover, after aggressive first-line chemotherapy, some patients can undergo surgical resection of the metastases, initially considered as unresectable. We still do not know if these aggressive first-line therapies should be proposed to all metastatic patients or only to a selected subgroup. The best strategies remain to be evaluated. IN THE SETTING OF ADJUVANT CHEMOTHERAPY: Of colorectal cancer, a 6-month 5-FU/folinic acid postoperative chemotherapy is actually the standard for the management of patients with positive lymph nodes (stage III). In stage II patients the benefit of such treatment remains controversial. The benefit of using oxaliplatin or irinotecan in association with 5-FU/folinic acid as adjuvant therapy is under investigation. CONCLUSION: In this 21st century, chemotherapy has a major place in the therapeutic management of colorectal cancer patients. 相似文献
18.
Background Liver metastases develop in 40–50% of patients with colorectal cancer and represent the major cause of death in this disease.
Surgical resection remains the only treatment procedure that can ensure long-term survival and provide cure when liver metastases
can be totally resected with clear margins, when the primary cancer is controlled, and when there is no nonresectable extrahepatic
disease. Five-year survival rate after surgical resection of colorectal metastases varies from 25% to 55%, but cancer relapse
is observed in most patients.
Aim To review the potential benefits and disadvantages of neoadjuvant chemotherapy administered before surgery to patients with
initially resectable metastases.
Results European Organization for Research and Treatment of Cancer (EORTC) study 40983 has shown that neoadjuvant chemotherapy could
reduce the risk of relapse by one-quarter, and allows to test the chemosensitivity of the cancer, to help to determine the
appropriateness of further treatments, and to observe progressive disease, which contraindicates immediate surgery. Neoadjuvant
chemotherapy can induce damage to the remnant liver. Oxaliplatin-based combination regimen is associated with increased risk
of vascular lesions, whereas irinotecan-containing regimens have been associated with increased risks of steatosis and steatohepatitis.
Analysis of EORTC study 40983 showed that administration of six cycles of neoadjuvant systemic chemotherapy with 5-fluorouracil,
leucovorin, and oxaliplatin (FOLFOX) was associated with moderate increase of the risk of reversible complications after surgery,
but mortality rate was below 1% and not increased. If patients are not overtreated, chemotherapy before surgery is well tolerated.
The integration of novel targeted agents in combination with cytotoxic drugs is a promising way to improve outcome in patients
with advanced colorectal cancer. Preliminary trials have shown that targeted agents combined with cytotoxic regimens can increase
tumor response rates. Another impact of preoperative chemotherapy is that metastases that respond to treatment may no longer
be visible on computed tomography (CT) scan or at surgery. Patients should be carefully monitored and receive surgery before
metastases disappear.
Conclusion Treatment of most patients with liver metastases—those with resectable metastases as well as those with initially unresectable
metastases—should start with chemotherapy. If drugs are well chosen and the duration of treatment is monitored with care during
multidisciplinary meetings, benefits largely outweigh potential disadvantages. 相似文献
19.
Frank Makowiec Simone Möhrle Hannes Neeff Oliver Drognitz Gerald Illerhaus Oliver G. Opitz Ulrich T. Hopt Axel zur Hausen 《Journal of gastrointestinal surgery》2011,15(1):153-164
Background
Systemic chemotherapy (CTx) is increasingly used before surgery for colorectal liver metastases (CRC-LM). However, CTx may cause liver injury like steatosis, steatohepatitis, and sinusoidal injury which may be associated with postoperative morbidity. Some recent data have even shown an increased mortality in patients with CTx-associated steatohepatitis. We, therefore, analyzed our recent experience with potential hepatic injury and its association with CTx and morbidity in patients undergoing surgery for CRC-LM. 相似文献20.
Aamir Z. Khan Gareth Morris-Stiff Masatoshi Makuuchi 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(2):137-144
Background and aims Neoadjuvant chemotherapy is increasingly being used to enlarge the cohort of patients who can be offered hepatic resection
for malignancy. However, the impact of these agents on the liver parenchyma itself, and their effects on clinical outcomes
following hepatic resection remain unclear. This review identifies patterns of regimen-specific chemotherapy-induced hepatic
injury and assesses their impact on outcomes following hepatic resection for colorectal liver metastases (CLM).
Methods An electronic search was performed using the MEDLINE (US Library of Congress) database from 1966 to May 2007 to identify relevant
articles related to chemotherapy-induced hepatic injury and subsequent outcome following hepatic resection.
Results The use of the combination of 5-flourouracil and leucovorin is linked to the development of hepatic steatosis, and translates
into increased postoperative infection rates. A form of non-alcoholic steatohepatitis (NASH) related to chemotherapy and otherwise
known as chemotherapy-associated steatohepatitis (CASH) is closely linked to irinotecan-based therapy and is associated with
inferior outcomes following hepatic surgery mainly due to hepatic insufficiency and poor regeneration. Data on sinusoidal
obstruction syndrome (SOS) following treatment with oxaliplatin are less convincing, but there appears to be an increased
risk for intra-operative bleeding and decreased hepatic reserve associated with the presence of SOS. Intra-arterial floxuridine
therapy damages the extrahepatic biliary tree in addition to causing parenchymal liver damage, and has been shown to be associated
with increased morbidity after hepatic resection.
Conclusion Agent-specific patterns of damage are now being recognized with increasing use of neoadjuvant chemotherapy prior to surgery.
The potential benefits and risks of these should be considered on an individual patient basis prior to hepatic resection. 相似文献