Système gastro-intestinal et digestif

Abstrait

Synchronous Liver Resection with Cytoreductive Surgery for the Treatment of Liver and Peritoneal Metastases from Colon Cancer: Results from an Australian Centre

Alzahrani N, Ung L, Valle SJ, Ferguson J, Liauw W, Morris DL

Background: Treatment of peritoneal metastases (PM) and liver metastases (LM) from colon cancer remains controversial. LM has been viewed as exclusion criterion for cytoreductive surgery (CRS) on the basis that such spread represents systemic disease. CRS and intra-peritoneal chemotherapy (IPC) has gained increasing recognition as a treatment modality for selected patients with colon cancer and PM. This study analyses results of CRS and IPC for colon cancer and synchronous resection for treatment of LM and PM.

Methods: Seventy-eight patients with PM/LM colon cancer were analysed. Forty-two patients with PM were treated for disease limited to the peritoneum (A), and 36 patients received treatment for both PM and LM (B). Overall survival (OS), disease-free survival (DFS), morbidity, mortality, and recurrence were compared.

Results: Median overall (OS) and disease-free survival (DFS) was 32.8 and 13.5 months. The median OS for A and B were 45.5 and 24.4 months respectively. Within B patients, 18 had a PCI>7 and >3 LM and median survival of 21.8 months compared to 18 patients with PCI ≤ 7 and LM ≤ 3 with median survival of 38.4 months. Median DFS for A and B were 17.7 and 8.5 months respectively. Twenty-seven in total experienced major complications following surgery. Sixty-one patients recurred. Of A, 71.4% recurred compared to B at 86.1%.

Conclusion: While our study is limited, it has demonstrated encouraging evidence that long-term survival outcomes can be achieved in this small but significant number of patients treated by CRS/IPC and additional synchronous liver resection with no significant increase in morbidity when compared to CRS/IPC alone.