Unit:
Κατεύθυνση Χειρουργική ΟγκολογίαLibrary of the School of Health Sciences
Supervisors info:
Τούτουζας Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ζωγράφος Γεώργιος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Θεοδώρου Δημήτριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Σύγχρονη εκτομή ηπατικών μεταστάσεων σε κολοορθικό καρκίνο
Translated title:
Simultaneous resection of colorectal cancer liver metastases
Summary:
Introduction: Colorectal cancer is the second most common cause of death from malignancy worldwide. Both environmental and genetic factors contribute to the manifestation of the disease and its prognosis varies according to stage, being significantly reduced in patients with synchronous liver metastases, which are detected in approximately 20-30% of patients at the time of initial diagnosis. Liver metastases in colorectal cancer are mainly treated by surgery when applicable and secondarily by chemotherapy and radiotherapy. The timing of surgical resection of liver lesions is still under investigation, since the three alternatives remain object of further study. The surgical options are the sequential approach of treating the primary tumour first and afterwards the liver metastases, the liver first approach and finally the simultaneous surgical resection of both primary and secondary tumors.
Aim: The aim of this study is to present colorectal cancer with liver metastases as a clinical entity, to describe the surgical treatment options and to compare the synchronous resection to the other approaches.
Methods: A literature review of published studies was conducted based on predefined criteria. Finally, 23 articles were included, which were studied for information regarding the three surgical approaches for the treatment of hepatic secondary lesions in colorectal cancer. A comparison of their possible outcomes was made and other essential factors influencing the decision, such as patient selection criteria or technical considerations to be taken into account, were highlighted.
Discussion and conclusions: It is shown that the simultaneous approach is associated with similar morbidity and mortality rates compared to the metachronous liver resection and the liver first approach, as well as with shorter hospital stays. In addition, both primary neoplasm and liver lesions can be treated in a single operation, thus reducing potential delays in the further treatment of liver metastases and overall healthcare costs. Finally, since the synchronous resection is associated with similar or even improved overall survival rates compared to the other therapeutic approaches, it is considered as a safe treatment option for patients with colorectal cancer liver metastases. A multidisciplinary approach is initially necessary to evaluate candidate patients and formulate individualized treatment plans.
Main subject category:
Health Sciences
Keywords:
Metastatic colorectal cancer, Liver metastases, Synchronous liver metastases, Staged resection, Metachronous resection, Simultaneous resection, Liver first approach
