Онкология COMBINED TREATMENT FOR RESECTABLE COLORECTAL CANCER METASTASES IN THE LIVER EXHIBITING POOR PROGNOSIS
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ONCOLOGY BULLETIN OF THE VOLGA REGION

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COMBINED TREATMENT FOR RESECTABLE COLORECTAL CANCER METASTASES IN THE LIVER EXHIBITING POOR PROGNOSIS

S.L. Khays, K.G. Mamontov, A.F. Lazarev
Altay branch of the N.N. Blokhin Russian Cancer Research Center of the RAMS, Barnaul

 

Khays S.L. — research associate of the Department of Liver and Pancreas Surgery 25 Stroiteley St., fl. 26, Barnaul, Russian Federation, 656015, tеl. +7-923-643-39-88, e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра.

 

 

Abstract

Objective. The current study aimed to improve treatment effects for patients with resectable metastases of colorectal cancer in the liver exhibiting a poor prognosis.

Material and methods. Overall 240 patients were enrolled with metastatic colorectal cancer in the liver exhibiting at least one adverse factor of long-term prognosis: multiple metastases, bilobar liver metastases, large-size metastases, the presence of extrahepatic metastases, etc. All patients were divided into three groups, according to the type of combined treatment: combined treatment with adjuvant systemic chemotherapy (64 patients), combined treatment with perioperative systemic chemotherapy (54 patients), and combined treatment of perioperative regional chemotherapy (122 patients). All liver resections were extensive due to the widespread metastases. 

Results. Mortality among operated patients was 4%. The complication rate stood at 52%. Postoperative mortality and complications in the two groups were not statistically different, nor was the intraoperative blood loss in the two groups. Adding bevacizumab to preoperative chemotherapy did not increase blood loss.

After combined treatment with adjuvant chemotherapy the 5-year survival was 26±4%, significantly outperforming the 5-year survival rate after combined treatment with perioperative systemic chemotherapy (13±5%). Survival was also superior to the 5-year survival after combined treatment with perioperative regional chemotherapy (20±5%), although not statistically so.

Conclusion. The study demonstrates the benefits of combined treatment with adjuvant systemic chemotherapy for resectable colorectal cancer metastases in the liver exhibiting poor prognosis. For initially unresectable liver metastases in the absence of extrahepatic manifestations of the disease, treatment should begin with regional chemotherapy and biotherapy, whereas for initially unresectable metastases with extrahepatic manifestations of the disease, treatment should begin with systemic chemotherapy.

Key words: colorectal cancer metastases in the liver, poor prognosis, hemihepatectomy, adjuvant chemotherapy, perioperative chemotherapy.





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