Author/Editor		Potrč, Stojan; Horvat, Matjaž; Džokič, Mihajlo; Jagrič, Tomaž; Gajzer, Borut; Krebs, Bojan; Koželj, Miran; Andromako, Nikica; Gadžijev, Eldar; Ivanecz, Arpad
Title		Rezultati kirurškega zdravljenja resektabilnih jetrnih metastaz pri raku debelega črevesa in danke v UKC Maribor
Type		članek
Publication year		2008
Volume		str. 205-35
Language		slo
Abstract		Background: Only liver resection offers a chance for long term survival or even cure to the patients with liver metastases of colorectal cancer( CRC). Surgical procedure is nowadays often combined with other treatment modalities.The aim of the study was to present the multimodal treatment and toreveal the results of surgical treatment of patients with CRC liver metastases. Methods: Between July 1stt 1997 and June 31stt 2007 we performed 225 procedures on liver in 170 patients with colorectal cancer liver metastases (101 male, 69 female; mean age 61,8 years). The preoperative diagnostic workup and surgical procedure were standardized. Results: 74 patients had synchronic and 96 had meta-chronic liver metastases. 8.5 patients had unilobar and 85 had bilobar metastases. The average number of metastases was 3,1 per patient, the average diameter of metastases was 4cm. 28 patients had extra hepatic disease. Altogether 75 I patients were submitted for preoperative chemotherapy. Portal embolisation has been performed in 16 originally unresectable patients due to small liver remnant. Simultaneous liver resection and large bowel resection was done in 15 patients. As first operation R0 resection was performed in 116 patients R1 in 21 patients and R2 in 4 patients. A R0 liver resection was combined with radio-frequent tumor ablation (RFA ) in 12 patients. In 6 patients the RFA was performed by opened surgery and in 4 by percutaneous way. In 7 patients only explorative laparotomy was done. Two patients died within 30 days and 5 within 60 days in the perioperative period. In 39 patients who were readmitted for surgical therapy because of disease recurrence on the liver, 55 surgical procedures (1-4 per patient) were performed altogether. The allover 5 year survival for R0 resected patients was 40,2 %. (Abs. trunc. at 2000 ch.)
Summary		Izhodišča: Pri bolnikih z jetrnimi metastazami (JM) pri kolorektalnem raku (KRR) le kirurško zdravljenje, sedaj pogosto kombinirano z drugimi načini zdravljenja, nudi možnost dolgotrajnejšega preživetja ali pa celo upanje na ozdravitev. Namen raziskave je prikaz možnosti multimodalnega načina zdravljenja in ocenitev rezultatov zdravljenja JM pri KRR pri naših bolnikih. Metode: V obdobju od 1. julija 1997 do 31. junija 2007 smo pri 170 bolnikih z metastazami KRR (101 moški, 69 ženske; povprečna starost 61,8 let) opravili 225 kirurških postopkov. Rezultati: Pri 74 bolnikih je šlo za sinhrone pri 96 pa za metahrone JM. 85 bolnikov je imelo unilobarne, 85 pa bilobarne metastaze. Povprečno so bile 3,1 jetrne metastaze, povprečna velikost metastaz pa 4 cm. Pri 28 bolnikih je bilo obolenje prisotno tudi zunaj jeter. 75 bolnikov je pred jetrno operacijo prejemalo neadjuvantno kemoterapijo, 11 pa adjuvantno kemoterapijo. Pri 16 bolnikih je bila pred resekcijo jeter napravljena portalna embolizacija. Simultana resekcija je bila narejena pri 15 bolnikih. Pri prvi operaciji je bila pri 116 bolnikih R0, pri 21 R1 in pri 4 bolnikih R2 resekcija jeter. Pri 12 bolnikih je bila sicer R0 resekcija kombinirana še z radiofrekventno ablacijo metastaze (RFA). 6 bolnikov je imelo operativno RFA, 4 pa perkutano RFA. Pri 7 bolnikih je bila narejena le eksplorativna laparotomija. V obdobju 30 dni po operaciji sta umrla 2 bolnika, 5 pa v 60 dneh po operaciji. Zaradi ponovitve obolenja smo operirali 39 bolnikov, pri katerih smo opravili 55 posegov (1-4 na bolnika). 5-letno preživetje pri bolnikih z R0 resekcijo JM je bilo 40,2 %. Zaključki: Resekcije jeter so varne (morbiditeta: 19,4 %; 60 dnevna mortaliteta: 0,8 %), glede na pričakovano 5 letno preživetje (40 %) pa trenutno predstavljajo najučinkovitejši način zdravljenja bolnikov z metastazami KRR. Poudarjen je pomen multidisciplinarnega pristopa in multimodalnega zdravljenja bolnikov z metastazami KRR.
Descriptors		COLORECTAL NEOPLASMS NEOPLASM METASTASIS HEPATECTOMY SURVIVAL