共查询到20条相似文献,搜索用时 15 毫秒
1.
Survival After Resection of Multiple Hepatic Colorectal Metastases 总被引:17,自引:1,他引:16
Background: Hepatic resection is potentially curative in selected patients with colorectal metastases. It is a widely held practice that multiple colorectal hepatic metastases are not resected, although outcome after removal of four or more metastases is not well defined.Methods: Patients with four or more colorectal hepatic metastases who submitted to resection were identified from a prospective database. Number of metastases was determined by serial sectioning of the gross specimen at the time of resection. Demographic data, tumor characteristics, complications, and survival were analyzed.Results: From August 1985 to September 1998, 155 patients with four or more metastatic tumors (range 4–20) underwent potentially curative resection by extended hepatectomy (39%), lobectomy (42%), or multiple segmental resections (19%). Operative morbidity and mortality were 26% and 1%, respectively. Actuarial 5-year survival was 23% for the entire group (median 5 32 months) and there were 12 actual 5-year survivors. On multivariate analysis, only number of hepatic tumors (P = .005) and the presence of a positive margin (P = .003) were independent predictors of poor survival.Conclusions: Hepatic resection in patients with four or more colorectal metastases can achieve long-term survival although the results are less favorable as the number of tumors increases. Number of hepatic metastases alone should not be used as a sole contraindication to resection, but it is clear that the majority of patients will not be cured after resection of multiple lesions.Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, March 16–19, 2000, New Orleans. 相似文献
2.
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
3.
Background Some reports support resection combined with cryotherapy for patients with multiple bilobar colorectal liver metastases (CRLM)
that would otherwise be ineligible for curative treatments. This series demonstrates long-term results of 415 patients with
CRLM who underwent resection with or without cryotherapy.
Methods Between April 1990 and January 2006, 291 patients were treated with resection only and 124 patients with combined resection
and cryotherapy. Recurrence and survival outcomes were compared. Kaplan-Meier and Cox-regression analyses were used to identify
significant prognostic indicators for survival.
Results Median length of follow-up was 25 months (range 1–124 months). The 30-day perioperative mortality rate was 3.1%. Overall median
survival was 32 months (range 1–124 months), with 1-, 3- and 5-year survival values of 85%, 45% and 29%, respectively. The
overall recurrence rates were 66% and 78% for resection and resection/cryotherapy groups, respectively. For the resection
group, the median survival was 34 months, with 1-, 3- and 5- year survival values of 88%, 47% and 32%, respectively. The median
survival for the resection/cryotherapy group was 29 months, with 1-, 3- and 5-year survival values of 84%, 43% and 24%, respectively
(P = 0.206). Five factors were independently associated with an improved survival: absence of extrahepatic disease at diagnosis,
well- or moderately-differentiated colorectal cancer, largest lesion size being 4 cm or less, a postoperative CEA of 5 ng/ml
or less and absence of liver recurrence.
Conclusions Long-term survival results of resection combined with cryotherapy for multiple bilobar CRLM are comparable to that of resection
alone in selected patients. 相似文献
4.
M. Schiesser J. W. C. Chen G. J. Maddern R. T. A. Padbury 《Journal of gastrointestinal surgery》2008,12(6):1054-1060
Background Hepatic resection is the treatment of choice in patients with colorectal liver metastases. Perioperative morbidity is associated
with decreased long-term survival in several cancers. The aim of this study was to assess the impact of perioperative morbidity
and other prognostic factors on the outcome of patients undergoing liver resection for colorectal metastases.
Methods One hundred ninety seven patients undergoing liver resection with curative intent were investigated. The influence of prognostic
factors, such as complications, tumor stage, margins, age, sex, number of lesions, transfusion, portal inflow obstruction,
and era and type of resection, was assessed using univariate and multivariate analysis. Complications were graded using an
objective surgical complication classification.
Results The 5-year survival rate was 38%, with a median follow up of 4.5 years. The disease-free survival rate at 5 years was 23%.
The perioperative morbidity and mortality rates were 30 and 2.5%, respectively. The median survival of patients with perioperative
complications was 3.2 years, compared to 4.4 years in those patients without complications (p < 0.01). For patients with positive resection margins, the median survival was 2.1 years, compared 4.4 years in patients
with a margin (p = 0.019).
Conclusion Perioperative morbidity and a positive resection margin had a negative impact on long-term survival in patients following
liver resection for colorectal metastases.
This paper has been presented at the annual meeting of the Royal Australian College of Surgeons 2006 and was accepted for
oral presentation at the IHPBA 2006 meeting in Edinburgh. 相似文献
5.
Pulitanò C Arru M Catena M Guzzetti E Vitali G Ronzoni M Venturini M Villa E Ferla G Aldrighetti L 《Annals of surgical oncology》2008,15(6):1661-1669
Background Although hepatic artery infusion chemotherapy (HAIC) of floxuridine (FUDR) for colorectal liver metastases (CLM) can produce
high response rates, data concerning preoperative HAIC are scarce. The aim of this study was to assess the feasibility and
results of liver resection after preoperative HAIC with FUDR.
Methods Between 1995 and 2004, 239 patients with isolated CLM received HAIC in our institution. Fifty of these patients underwent
subsequent curative liver resection (HAIC group). Short- and long-term results of the HAIC group were compared with the outcomes
of 50 patients who underwent liver resection for CLM without preoperative chemotherapy.
Results Postoperative morbidity rate were comparable between the two groups. Overall disease-free survival at 1 and 3 years after
hepatectomy were 77.5% and 57.5% in the HAIC group and 62.9% and 37% in the control group (P = .036). Overall survival from diagnosis of CLM at 1, 3, and 5 years were 97%, 59%, and 49% in the HAIC group versus 94%,
48%, and 35% in the control group (P = .097). When patients were stratified according to clinical-risk scoring (CRS) system, patients with more advanced disease
at the time of liver resection (CRS ≥3) had a median survival of 41 months in the HAIC group (n = 37) and 35 months in the control group (n = 34) (P = .031).
Conclusions HAIC of FUDR does not negatively affect the outcome of subsequent liver resection. Preoperative HAIC of FUDR may reduce liver
recurrence rate and improve long-term survival in patients with more advanced liver disease.
Part of this article was presented at the International Hepato-Pancreato-Biliary Association, 7th World Congress in Edinburgh,
Scotland, September 3–7, 2006. 相似文献
6.
Malik HZ Farid S Al-Mukthar A Anthoney A Toogood GJ Lodge JP Prasad KR 《Annals of surgical oncology》2007,14(12):3519-3526
Background The aim of this study was to analyze the outcome of patients that received neoadjuvant chemotherapy prior to resection for
colorectal liver metastases (CRLM) and compare them with a matched cohort of patients that underwent resection followed by
adjuvant chemotherapy.
Methods 687 patients have undergone curative resection between January 1993 and January 2006. In this period, 84 patients received
neo-adjuvant chemotherapy and 71 of this group went on to resection. A control group was chosen, matched with these patients,
made up of patients who underwent resection followed by adjuvant chemotherapy.
Results There was no difference in clinico-pathological features between the neoadjuvant and the control group. However patients in
the control group had more-extended resections and longer hospital stays than those in the neoadjuvant group (p = 0.015). Patients in the control group had an increased incidence of early recurrences (p < 0.001). Despite this, there was no significant difference in either the cancer-specific or the disease-free survival between
the two groups of patients.
Conclusion Neoadjuvant chemotherapy has a role in the management of patients with disease that is considered initially unresectable as
a down-sizing technique. In patients with resectable disease, the test-of-time approach that neoadjuvant therapy offers is
yet to be proven. 相似文献
7.
Timing of Resection of Liver Metastases Synchronous to Colorectal Tumor: Proposal of Prognosis-Based Decisional Model 总被引:2,自引:0,他引:2
Capussotti L Vigano' L Ferrero A Lo Tesoriere R Ribero D Polastri R 《Annals of surgical oncology》2007,14(3):1143-1150
Background Timing of hepatectomy for synchronous metastases of colorectal cancer is still debated. The aim of this retrospective study
was to analyze prognostic factors after synchronous and delayed liver resections to define selection criteria for choosing
timing of hepatectomy.
Methods The study was performed on 127 patients with synchronous metastases undergoing radical hepatectomy. We divided patients according
to the timing of hepatectomy: 70 synchronous (group A) and 57 delayed (group B).
Results Overall survival was similar between the two groups (5-year survival 30.8% vs. 32.0% A vs. B, P = .406). The multivariate analysis evidenced four independent prognostic factors in group A: male sex (P = .04), T4 (P = .0035), more than three metastases (P = .0001), and metastatic infiltration of nearby structures (P < .0001). There were no statistically significant prognostic factors in group B. Patients with more than three metastases
had a significantly worse survival in group A than in group B (3-year survival, 15.0% vs. 34.3%, P = .007); similarly, borderline significant difference was encountered in patients with T4 primary tumor (3-year survival,
16.7% vs. 60%, P = .064)
Conclusions Patients with liver metastases synchronous with colorectal cancer with T4 primary tumor, metastasis infiltration of neighboring
structures, and especially with more than three metastases should receive neoadjuvant chemotherapy before liver resection. 相似文献
8.
9.
Wei AC Greig PD Grant D Taylor B Langer B Gallinger S 《Annals of surgical oncology》2006,13(5):668-676
Background Metastatic colorectal cancer is a major cause of cancer death in North America. Hepatic resection offers the potential for
cure in selected patients. We report the long-term outcomes of patients who underwent hepatic resection for colorectal metastases
over a 10-year period at a single hepatobiliary surgical oncology center.
Methods All patients who underwent liver resection for metastatic colorectal cancer between 1992 and 2002 were identified. Data were
retrospectively obtained through chart review. Major outcome variables were disease-free survival and overall survival. Risk
factors for disease recurrence and mortality were identified by multivariate analysis by using the Cox proportional hazard
method.
Results A total of 423 hepatectomies were performed for metastatic colorectal cancer. Most operations (n = 276; 65%) were major (four
or more segments) hepatectomies. Perioperative morbidity occurred in 74 (17%) patients. There were seven (1.6%) perioperative
deaths. The disease-free survival at 1, 5, and 10 years was 64%, 27%, and 22%, respectively. The overall survival at 1, 5,
and 10 years was 93%, 47%, and 28%, respectively. Multivariate analysis identified four negative predictive factors for overall
survival (hazard ratio; 95% confidence interval): a positive surgical margin (2.9; 1.5–5.3), large metastases (>5 cm; 1.5;
1.1–2.0), multiple metastases (1.4; 1.1–1.9), and age >60 years (1.4; 1.1–1.9).
Conclusions Hepatic resection for metastatic colorectal cancer is safe and provides good long-term overall survival rates of 47% at 5
years and 28% at 10 years. An aggressive approach is justified by the low operative mortality rate and good long-term survival,
even in individuals with multiple bilobar metastases. 相似文献
10.
Isolated Hepatic Perfusion for the Treatment of Patients With Colorectal Cancer Liver Metastases After Irinotecan-Based Therapy 总被引:5,自引:5,他引:0
Alexander HR Libutti SK Pingpank JF Bartlett DL Helsabeck C Beresneva T 《Annals of surgical oncology》2005,12(2):138-144
Background Irinotecan given with 5-fluorouracil and leucovorin is currently used as first-line therapy for patients with metastatic colorectal cancer (CRC). However, the response duration is <1 year, and second-line systemic chemotherapy has limited efficacy. We analyzed the efficacy of isolated hepatic perfusion (IHP) for patients with progressive CRC liver metastases after irinotecan.Methods Between March 1993 and February 2003, 124 patients with CRC liver metastases underwent IHP on institutional review board–approved protocols. The overall treatment mortality was 4% (5 of 124). Twenty-five patients (10 women and 15 men; mean age, 53 years) were identified who had progressive liver metastases by carcinoembryonic antigen, imaging studies, or both after irinotecan. A 1-hour hyperthermic IHP (mean hepatic temperature, 40.0°C) with melphalan 1.5 mg/kg (mean total dose, 100 mg) was administered via laparotomy. Perfusion with an oxygenated extracorporeal circuit was established with inflow via a cannula in the gastroduodenal artery and common hepatic artery inflow occlusion. Outflow was via a cannula in an isolated segment of the inferior vena cava. During IHP, portal and inferior vena caval flow were shunted to the axillary vein. Patients were assessed for radiographical response, recurrence pattern, and survival.Results The mean number of prior irinotecan cycles in 25 patients was 6 (range, 2–14), and it was given primarily as second-line therapy. The median number of liver metastases before IHP was 10 (range, 1–50), and the median percentage of hepatic replacement by tumor was 25%. The mean operative time was 9 hours (range, 6–12 hours), and the median hospital stay was 11 days (range, 8–76 days). There was 1 complete response and there were 14 partial responses in 25 patients (60%), with a median duration of 12 months (range, 5–35 months). Disease progressed systemically in 13 of 25 patients at a median of 5 months (range, 3–16 months). The median overall survival was 12 months (range, 1–47 months), and the 2-year survival was 28%.Conclusions For patients with progressive CRC liver metastases after irinotecan, IHP has good efficacy in terms of response rate and duration. Continued evaluation of IHP with melphalan as second-line therapy in this clinical setting is justified. 相似文献
11.
Gennaro Nuzzo Felice Giuliante Francesco Ardito Maria Vellone Carmelo Pozzo Alessandra Cassano Ivo Giovannini Carlo Barone 《Journal of gastrointestinal surgery》2007,11(3):318-324
This study was performed prospectively to assess the effect of systemic chemotherapy (FOLFIRI protocol) in patients with initially
unresectable colorectal liver metastases (CRLM) and, after performing liver resection in patients with downsized metastases,
to compare the postoperative and long-term results with those of patients with primarily resectable CRLM. Records from a prospective
database including all consecutive admissions for CRLM between June 2000 and June 2004 were reviewed. The analysis addressed
all patients who underwent hepatectomy for primarily resectable CRLM (Group A), or underwent chemotherapy for primarily unresectable
CRLM and among these, particularly the patients who were finally resected after downsizing of CRLM (Group B). There were 60
primarily resected patients (Group A). Forty-two other patients underwent chemotherapy; after an average of nine courses,
18 of them (42.8%) with significantly downsized lesions were explored and 15 (35.7%, Group B) were resected, whereas three
had peritoneal metastases. Group B differed from Group A for a significantly higher rate of synchronous CRLM upon diagnosis
of colorectal cancer, a larger size of CRLM upon evaluation in our center, and a lower rate of major hepatectomies (20.0%
vs. 51.6 %) at surgery. No patient in Group B had positive margins of resection. Operative mortality was nil and morbidity
was 20.0% in both groups. In Group B vs. Group A median survival after hepatectomy was 46 vs. 47 months (n.s), 3-year survival
rate was 73% vs. 71% (n.s.), disease-free survival rate was 31% vs. 58% (p = 0.04) and, at a median follow-up of 34 months, tumor recurrence rate was 53.3% vs. 28.3% (n.s.). Four out of the eight
Group B patients with recurrence underwent a re-resection, and were alive at 9 to 67 months after the first resection. These
results show that in about one-third of the patients with primarily unresectable CRLM, downsizing of the lesions by chemotherapy
(FOLFIRI protocol) permitted a subsequent curative resection. In these patients, operative risk and survival did not differ
from the figures observed in primarily resectable patients and, in spite of a lower disease-free survival with more frequent
recurrence, re-resection still represented a valid option to continue treatment.
Presented at the 2005 Surgical Spring Week AHPBA Meeting (April 14–17, 2005, Fort Lauderdale, Florida). 相似文献
12.
13.
Yoshiya Fujimoto Takayuki Akasu Seiichiro Yamamoto Shin Fujita Yoshihiro Moriya 《Journal of gastrointestinal surgery》2009,13(9):1643-1650
Background The prognosis of unresectable hepatic colorectal metastases is poor even if chemotherapy is administered. The purpose of this
study was to evaluate the long-term efficacy of hepatic arterial infusion (HAI) chemotherapy and hepatectomy following HAI
for such condition.
Methods Seventy-two patients with unresectable hepatic colorectal metastases received continuous HAI of 5-fluorouracil.
Results The overall response rate was 38%. The median survival of all patients was 18 months. The overall 3-year survival rate was
18%. Seven patients (10%) survived more than 58 months. Of the eight patients with a complete response, seven developed liver
and/or lung metastases, and of these, one patient undergoing additional hepatectomy has been disease-free and the other six
receiving chemotherapy died of disease. Another complete-response case died of liver abscess. Of the 19 patients with a partial
response, six could undergo hepatectomy after HAI. The overall 5-year survival rate of seven patients undergoing hepatectomy
was 71%, whereas for patients without hepatectomy, the rate was 0%.
Conclusions Most patients showing response after HAI for unresectable hepatic colorectal metastases had relapses. The long-term prognosis
of patients undergoing hepatectomy after HAI was favorable. Therefore, when HAI makes liver metastases resectable, they should
be resected. 相似文献
14.
目的:探讨结直肠癌切除同期射频消融联合化疗治疗肝转移的临床疗效。方法:对39例病人先行原发肿瘤的切除,同期行射频消融联合化疗治疗肝转移,以螺旋CT增强扫描为主结合彩超综合评价治疗效果。结果:39例共82个肝转移病灶,完全坏死率85%。随访时间〉6个月者3l例,生存27例;随访时间〉12个月11例,生存8例。结论:结直肠癌切除同期射频消融联合化疗治疗肝转移的疗效较好,值得临床推广。 相似文献
15.
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
16.
17.
Results of R0 Resection for Colorectal Liver Metastases Associated With Extrahepatic Disease 总被引:8,自引:2,他引:6
Elias D Sideris L Pocard M Ouellet JF Boige V Lasser P Pignon JP Ducreux M 《Annals of surgical oncology》2004,11(3):274-280
Background: Extrahepatic malignant disease has always been considered an absolute contraindication to hepatectomy for colorectal liver metastases. This study reports the long-term outcome and prognostic factors of patients undergoing extrahepatic disease resection simultaneously with hepatectomy for liver metastases.Methods: From January 1987 to January 2001, 75 patients underwent a complete R0 resection of extrahepatic disease simultaneously with hepatectomy for colorectal liver metastases. They were inscribed in a registry and then prospectively followed up. They represented 25% of the 294 patients who underwent an R0 hepatectomy for colorectal liver metastases during the same period.Results: The mortality rate was 2.7%, and morbidity was 25%. After a median follow-up of 4.9 years (range, 1.7–13.4 years), the overall 3- and 5-year survival rates were 45% and 28%, respectively. By using a Cox model, there was a significant difference in survival between patients with single versus multiple sites of extrahepatic disease. Also, the presence of more than five liver metastases was a significant parameter.Conclusions: Extrahepatic disease in colorectal cancer patients with liver metastases should no longer be considered as a contraindication to hepatectomy. However, this intended R0 resection cannot be performed in 50% of laparotomized patients, and negative prognostic factors for surgery include the presence of multiple extrahepatic disease sites or more than five liver metastases. 相似文献
18.
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
19.
Francesco Polistina Alessandro Fabbri Giovanni Ambrosino 《The Indian journal of surgery》2013,75(3):220-225
Resection is the only chance of cure for isolated liver metastases from colorectal cancer. In the case of extended parenchymal resections, one crucial point is the ischemic damage to the remnant liver. We report an alternative technique for extremely extended liver resections without total hilar clamping for borderline liver remnants. Two patients presented with invasion of the infrahepatic vena cava, both with an estimated live remnant ≤20 %. The crucial point of the technique is the absence of a portal triad clamping in under beating heart-extracorporeal circulation. In both patients resection margins were free of disease. No signs of liver insufficiency were noted. Survival was more than 2 years in both cases. We believe that aggressive treatment of liver colorectal metastases should be given to all suitable patients. This operation may be added to the techniques that can be offered to these patients. 相似文献
20.
Celina Ang MD Komal Jhaveri MD Dina Patel BSc Alexandra Gewirtz BA Andrew Seidman MD Nancy Kemeny MD 《The breast journal》2013,19(1):96-99
Hepatic failure from breast cancer liver metastases (BCLM) is a major cause of morbidity and mortality. We reviewed the treatment histories and outcomes of nine patients with heavily treated BCLM, who received hepatic arterial infusion (HAI) of floxuridine (FUDR)/dexamethasone (Dex) and systemic chemotherapy at our institution. Patients received a median of five (range 1–15) HAI treatments. There were seven (78%) objective responses. Four patients had grade 3 elevations in liver enzymes attributable to HAI. There were no treatment‐related deaths. Median hepatic and extrahepatic time to progression on HAI were both 6 months. Median survival after starting HAI was 17 months (range 1–115). Median overall survival from the original breast cancer diagnosis was 110 months (range 52–248). One patient is alive with stable disease on systemic therapy alone. HAI and systemic chemotherapy is feasible and can benefit selected patients with BCLM, who have progressed on prior therapies. Patients require close monitoring for treatment‐limiting toxicities. 相似文献