Kursat R. SERİN, Muhammed Z. UCUNCU, Onder KARABAY, M. Kemal TEMEL, Adnan HACİM, Cem TERZİ

Karaciğer Metastazlı Kolorektal Kanserde Kişiselleştirilmiş Tedavi Sonuçları

Amaç: Karaciğer metastazı, kolorektal kansere (KRK) bağlı ölümlerin en sık nedenidir. Daha iyi sağkalım sonuçları için tekrarlayan karaciğer metastazında kişiselleştirilmiş agresif lokal tedaviler önerilmektedir. Bu çalışmada seçilmiş bir grup metastatik KRK hastasında kaydedilen sonuçları paylaşmayı amaçladık. Gereç ve Yöntemler: Mart 2013—Kasım 2018 döneminde karaciğer metastazlı KRK tanısı alan ve cerrahi tedavi uygulanan toplam 45 (28 erkek, 17 kadın) hastanın verileri retrospektif olarak incelendi. Bulgular: Medyan hasta yaşı 61 yıl idi. Senkron metastazı bulunan 32 hastanın 21’i eş zamanlı ameliyat edildi. Metakron metastaz gelişimi için medyan süre 18 aydı. Bilober metastazlı 23 hastada medyan metastaz sayısı 4 (1–18) idi. On bir (10 senkron ve 1 metakron metastaz) hastada perioperatif kemoterapi uygulanmadan karaciğer rezeksiyonu yapıldı; diğer 34 hastada ise perioperatif tedavi uygulandı. Parankim-koruyucu karaciğer cerrahisi (metastazektomi / segmentektomi) 34 hasta ile en sık uygulanan cerrahi yaklaşım olurken yine onkolojik prensipler doğrultusunda (31 metastaz için) 10 hastada cerrahi–ablasyon kombinasyonu uygulandı. Medyan tümör boyutu 35 mm, medyan cerrahi sınır 3 mm idi. Dört hastada cerrahi sınır pozitifti; bu 4 hastadan sadece 1’inde lokal nüks gelişti. Toplam 20 hastada medyan 12 aylık dönemde reküren karaciğer metastazı gelişti; bu hastalara tekrar cerrahi tedavi uygulandı. Medyan sağkalım süresi 45 hastanın tümü için 32 ay, nüks nedeniyle ikincil cerrahi uygulanan 12 hasta içinse 36 ay olarak saptandı. Tartışma ve Sonuç: Karaciğer metastazlı KRK’de agresif, kişiselleştirilmiş, multidisipliner tedaviler daha iyi uzun dönem sağkalım sağlamaktadır. Senkron veya aşamalı girişimler kabul edilebilir morbidite ve mortalite oranları ile uygulanabilir. Reküren metastazlarda cerrahi tedavi şansını artırmak için parankim-koruyucu cerrahiler seçilmelidir.

Anahtar Kelimeler:

hepatektomi, karaciğer rezeksiyonu, metastazektomi, mikro dalga ablasyon

Results of Individualized Treatment of Colorectal Cancer with Liver Metastasis

Aim: Liver metastasis is the most common cause of death in colorectal cancer (CRC). In cases of recurrent liver metastasis, individualized aggressive local treatments are recommended for better survival outcomes. In this study, we aimed to present the health outcomes obtained in a group of highly selected patients with metastatic CRC. Materials and Methods: Medical records of a total of 45 (28 males, 17 females) patients who were diagnosed with CRC with liver metastasis and underwent surgical treatment between March 2013 and November 2018 were reviewed retrospectively. Results: The median patient age was 61 years. Thirty-two patients were diagnosed with synchronous metastasis, of whom 21 underwent synchronous surgery. The median time for metachronous metastasis development was 18 months. Twenty-three patients developed bilobar metastasis, with a median number of 4 (1–18) metastases. Eleven (10 synchronous and 1 metachronous metastasis) patients underwent liver resection without perioperative chemotherapy while the other 34 received perioperative treatment. While parenchyma-preserving liver surgery (metastasectomy/segmentectomy) as performed in 34 patients was the most common surgical approach, surgery in 10 patients (for 31 metastasis) was combined with ablation, again in accordance with the oncological principles. The median tumor size and surgical margin were 35 mm and 3 mm, respectively. Surgical margin was positive in 4 patients, of whom only 1 developed local recurrences. In a median time of 12 months, a total of 20 patients developed recurrent liver metastasis, and 12 of them underwent surgery again. The median survival was 32 months for all 45 patients and 36 months for the 12 patients who underwent secondary surgery due to recurrence. Discussion and Conclusion: Aggressive, individualized, multidisciplinary treatments could provide better long-term survival outcomes in CRC with liver metastasis. Synchronous or staged interventions are applicable with acceptable morbidity and mortality rates. In cases of recurrent metastasis, parenchyma-preserving procedures should be preferred for increased chances of repeated surgical treatment.

Keywords:

hepatectomy, liver resection, metastasectomy, microwave ablation,

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