Τετάρτη, 15 Φεβρουαρίου 2017

SURVIVAL OF POLYMETASTATIC COLORECTAL CANCER PATIENTS

Colorectal Cancer Liver Metastases and Concurrent Extrahepatic Disease Treated With Resection 

Leung U, Gönen M, Allen PJ, et al
Ann Surg. 2017;265:158-165.

Summary

What is the expected outcome in patients with synchronous liver and extrahepatic metastatic disease associated with colorectal cancer (CRC)? The authors report findings from 219 patients with this unfavorable combination of metastatic cancer.
About one half of the patients required major hepatectomy, involving removal of three or more liver sections. The most common sites of extrahepatic disease were lung (26%), retroperitoneal lymph nodes (18%), and peritoneum (16%). After 5 years, there were 37 survivors (17%), and at 10 years there were five patients with no evidence of disease.

Viewpoint

Over the past few decades, resection of metastatic liver cancer in selected patients with CRC has become an accepted method of treatment. This report provides information about a subset of these patients with hepatic metastases and simultaneous extrahepatic cancer.
Despite these unfavorable findings, 17% of patients became 5-year survivors after resection of liver and extrahepatic metastatic disease. The size and number of liver metastases were predictors of survival (P = .001 and .012, respectively), as was the site of extrahepatic metastases (P = .001). Extrahepatic cancer in the adrenal gland or at the anastomotic site had the best survival rates.
This report, although not a randomized trial, tells surgeons and patients that a selected few patients with both hepatic and extrahepatic cancer can be expected to survive for 5 years, although nearly all of these patients did eventual die of CRC.

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