A doença maligna extra-hepática sempre tem sido considerada uma contra-indicação absoluta para hepatectomia de metástases hepáticas de câncer colorretal. Em um artigo publicado recentemente na Annals of Surgical Oncology, os autores relatam os resultados a longo prazo e fatores prognósticos de pacientes submetidos à ressecção de doença extra- hepática simultaneamente com hepatectomia de metástases hepáticas.
Entre janeiro de 1987 e janeiro de 2001, 75 pacientes foram submetidos à ressecção R0 de doença extra-hepática simultaneamente com hepatectomia de metástases hepáticas de câncer colorretal. Eles foram inscritos em um registro e então acompanhados prospectivamente. Estes pacientes representavam 25% dos 294 pacientes que foram submetidos à hepatectomia R0 de metástases hepáticas de câncer colorretal durante o mesmo período.
A taxa de mortalidade foi de 2.7% e a morbidade foi de 25%. Após um período médio de 4.9 anos de seguimento (variação entre 1.7-13.4 anos), as taxas de sobrevida média entre 3 e 5 anos foram de 45% e 28%, respectivamente. Através de um modelo de Cox, houve diferença significativa na sobrevida entre pacientes com regiões isolada versus múltiplas de doença extra- hepática. Além disso, a presença de mais de 5 metástases hepáticas foi um parâmetro significativo.
Os autores concluíram que a doença extra-hepática em pacientes com câncer colorretal com metástases hepáticas não deveria ser mais considerada uma contra-indicação para hepatectomia. No entanto, esta ressecção R0 não pode ser realizada em 50% dos pacientes submetidos à laparotomia e os fatores prognósticos negativos para cirurgia incluem a presença de sítios de doença múltipla extra-hepática ou mais do que 5 metástases hepáticas.
Results of R0 Resection for Colorectal Liver Metastases Associated With Extrahepatic Disease - Annals of Surgical Oncology 11:274-280 (2004)
Originally published as Ann Surg Oncol Early Release 10.1245/ASO.2004.03.085 on February 9, 2004
Annals of Surgical Oncology 11:274-280 (2004)
© 2004 Society of Surgical Oncology
Results of R0 Resection for Colorectal Liver Metastases Associated With Extrahepatic Disease
Dominique Elias, MD, PhD, Lucas Sideris, MD, FRCSC, Marc Pocard, MD, PhD, Jean-Francois Ouellet, MD, FRCSC, Valérie Boige, MD, Philippe Lasser, MD, Jean-Pierre Pignon, MD, PhD and Michel Ducreux, MD
From the Departments of Surgical Oncology (DE, LS, MP, J-FO, PL), Medical Oncology (VB, MD), and Biostatistics and Epidemiology (J-PP), Gustave Roussy Institute, Villejuif, France.
Correspondence: Address correspondence and reprint requests to: Dominique Elias, MD, PhD, Department of Surgery, Division of Surgical Oncology, Gustave Roussy Institute, Rue Camille Desmoulins, 94805, Villejuif CEDEX, France; Fax: 33-1-42-11-52-56; E-mail: elias@igr.fr.
Background: Extrahepatic malignant disease has always been considered an absolute contraindication to hepatectomy for colorectal liver metastases. This study reports the long-term outcome and prognostic factors of patients undergoing extrahepatic disease resection simultaneously with hepatectomy for liver metastases.
Methods: From January 1987 to January 2001, 75 patients underwent a complete R0 resection of extrahepatic disease simultaneously with hepatectomy for colorectal liver metastases. They were inscribed in a registry and then prospectively followed up. They represented 25% of the 294 patients who underwent an R0 hepatectomy for colorectal liver metastases during the same period.
Results: The mortality rate was 2.7%, and morbidity was 25%. After a median follow-up of 4.9 years (range, 1.7–13.4 years), the overall 3- and 5-year survival rates were 45% and 28%, respectively. By using a Cox model, there was a significant difference in survival between patients with single versus multiple sites of extrahepatic disease. Also, the presence of more than five liver metastases was a significant parameter.
Conclusions: Extrahepatic disease in colorectal cancer patients with liver metastases should no longer be considered as a contraindication to hepatectomy. However, this intended R0 resection cannot be performed in 50% of laparotomized patients, and negative prognostic factors for surgery include the presence of multiple extrahepatic disease sites or more than five liver metastases.
Key Words: Liver metastases • Colorectal • Extrahepatic disease • Surgery
