Management of patients with synchronous colorectal liver metastases. An update and analysis of a patient group with these characteristics in a tertiary University Hospital.

Postgraduate Thesis uoadl:2940000 100 Read counter

Unit:
Κατεύθυνση Χειρουργική Ογκολογία
Library of the School of Health Sciences
Deposit date:
2021-03-23
Year:
2021
Author:
Roditis Spyridon
Supervisors info:
Μανούσος Κωνσταντουλάκης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Κωνσταντίνος Γ. Τούτουζας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νικόλαος Αλεξάκης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Αντιμετώπιση ασθενών με σύγχρονες ηπατικές μεταστάσεις από κολοορθικό καρκίνο. Ανάλυση του θέματος και πρωτογενής ανάλυση των δεδομένων από την αντιμετώπιση ομάδας ασθενών με αυτά τα χαρακτηριστικά σε ένα τριτοβάθμιο Πανεπιστημιακό Νοσοκομείο.
Languages:
Greek
Translated title:
Management of patients with synchronous colorectal liver metastases. An update and analysis of a patient group with these characteristics in a tertiary University Hospital.
Summary:
Liver is the most common location of colorectal metastasis (CRLM). Synchronous CRLM is a negative prognostic biomarker of the disease. Depending on the colorectal tumor and the extent and anatomic locations of the liver metastatic foci there can be multiple surgery strategies on the range and sequence of the treatment.
If the primary colorectal tumor is symptomatic (perforation, bleeding, obstruction) and the metastases are operable or not, treatment algorithms are followed, prioritizing the sequence of operations and perioperative chemotherapy. The main goal for the liver surgery candi-dates is to avoid postoperative liver failure. Apart from resection there are other strategies of liver metastasis treatment such as radiofrequency, local ablative thermal therapies, mi-crowave ablation, cryotherapy or hepatic arterial infusion therapies although they are infe-rior to surgery.
In this retrospective study, the patients with synchronous CRLM that were treated with surgery between 2003-2019 from a tertiary University hospital were analyzed. Data rec-orded variables such as sex, age, CEA serum levels, location of the primary tumor, T- and N-stage of the primary tumor, number, size and location of metastatic foci in the liver, as well as the adequacy of the resection (R status) and the surgical strategy (simultaneous resection, versus the resection of the primary first) were analyzed. Survival data were also recorded with the primary endpoint being to analyze if there was a difference in Overall Survival (OS) between the two surgical strategies. Univariate and multivariate regression analysis showed significantly worse OS for patients operated for the colorectal tumor and liver metastasis simultaneously, versus the resection of the primary tumor first (p=0.003) for large liver metastases (>=5cms), (p=0.020) and for N(+) primary tumors (p=0,019).
Prospective randomized studies with large number of patients, are required for definitive and safer conclusions.
Keywords: synchronous liver metastases, colorectal cancer, simultaneous excision, liver metastases size, nodular positive tumor
Main subject category:
Health Sciences
Keywords:
Synchronous liver metastases, Colorectal cancer, Simultaneous excision, Liver metastases size, Nodular positive tumor
Index:
Yes
Number of index pages:
2
Contains images:
Yes
Number of references:
119
Number of pages:
87
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