Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases

被引:58
作者
Capussotti, L.
Muratore, A.
Mulas, M. M.
Massucco, P.
Aglietta, M.
机构
[1] Ist Ric & Cura Canc, Div Surg Oncol, I-10060 Candiolo, Italy
[2] Ist Ric & Cura Canc, Div Med Oncol, I-10060 Candiolo, Italy
关键词
D O I
10.1002/bjs.5386
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Hepatic surgery is the treatment of choice for resectable colorectal liver metastases. Neoadjuvant chemotherapy can downstage the tumour and enable surgery in up to 38 per cent of patients whose tumours were initially considered irresectable. Methods: This prospective study included 150 patients who underwent hepatic resection over a 4-year period. One hundred and sixteen patients had resection without neoadjuvant chemotherapy (group 1) and 34 had chemotherapy before liver surgery (group 2). Perioperative features, survival and pattern of recurrence were compared. Results: Median follow-up was 35.1 months. The in-hospital mortality rate was zero. Three-year overall survival in the two groups was comparable (P = 0.232). The 3-year disease-free survival rate was 21 per cent in the neoadjuvant group compared with 50.5 per cent in the immediate resection group (P < 0.001). Recurrence rates were 94 per cent (32 of 34) in group 1 and 66.4 per cent in group 2 (P = 0.001); extrahepatic recurrence, alone or associated with recurrence in the liver, was significantly more common in group 2 than in group 1 (78 versus 55 per cent; P = 0.016). Multivariate analysis revealed that resection of the recurrence was the most important independent prognostic factor for improved disease-free survival (relative risk 0.2; P < 0.001). Patients in group 2 had reduced disease-free survival (RR 1.8; P = 0.012). Conclusion: The recurrence rate among patients who had neoadjuvant chemotherapy and surgery for initially irresectable liver metastases was extremely high. Re-resection should be attempted whenever feasible.
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页码:1001 / 1006
页数:6
相关论文
共 21 条
[1]   Tumor progression while on chemotherapy - A contraindication to liver resection for multiple colorectal metastases? [J].
Adam, R ;
Pascal, G ;
Castaing, D ;
Azoulay, D ;
Delvart, V ;
Paule, B ;
Levi, F ;
Bismuth, H .
ANNALS OF SURGERY, 2004, 240 (06) :1052-1064
[2]  
Adam R, 2004, ANN SURG, V240, P644, DOI 10.1097/01.sla.0000141198.92114.16
[3]  
Adam R, 2001, ANN SURG ONCOL, V8, P347
[4]   Liver resection for colorectal metastases - The third hepatectomy [J].
Adam, R ;
Pascal, G ;
Azoulay, D ;
Tanaka, K ;
Castaing, D ;
Bismuth, H .
ANNALS OF SURGERY, 2003, 238 (06) :871-883
[5]   Hepatic resection for colorectal metastases - Analysis of prognostic factors [J].
Ambiru, S ;
Miyazaki, M ;
Isono, T ;
Ito, H ;
Nakagawa, K ;
Shimizu, H ;
Kusashio, K ;
Furuya, S ;
Nakajima, N .
DISEASES OF THE COLON & RECTUM, 1999, 42 (05) :632-639
[6]   Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy [J].
Bismuth, H ;
Adam, R ;
Levi, F ;
Farabos, C ;
Waechter, F ;
Castaing, D ;
Majno, P ;
Engerran, L .
ANNALS OF SURGERY, 1996, 224 (04) :509-520
[7]   Trends in long-term survival following liver resection for hepatic colorectal metastases [J].
Choti, MA ;
Sitzmann, JV ;
Tiburi, MF ;
Sumetchotimetha, W ;
Rangsin, R ;
Schulick, RD ;
Lillemoe, KD ;
Yeo, CJ ;
Cameron, JL .
ANNALS OF SURGERY, 2002, 235 (06) :759-765
[8]  
DAngelica M, 1997, J AM COLL SURGEONS, V185, P554
[9]   Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer [J].
de Gramont, A ;
Figer, A ;
Seymour, M ;
Homerin, M ;
Hmissi, A ;
Cassidy, J ;
Boni, C ;
Cortes-Funes, H ;
Cervantes, A ;
Freyer, G ;
Papamichael, D ;
Le Bail, N ;
Louvet, C ;
Hendler, D ;
de Braud, F ;
Wilson, C ;
Morvan, F ;
Bonetti, A .
JOURNAL OF CLINICAL ONCOLOGY, 2000, 18 (16) :2938-2947
[10]   Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer - Analysis of 1001 consecutive cases [J].
Fong, Y ;
Fortner, J ;
Sun, RL ;
Brennan, MF ;
Blumgart, LH .
ANNALS OF SURGERY, 1999, 230 (03) :309-318