切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (04) : 330 -335. doi: 10.3877/cma.j.issn.2095-3224.2017.04.014

所属专题: 经典病例 文献

病例讨论

结直肠癌肝脏、腹主动脉旁淋巴结寡转移的MDT策略
古朝阳1, 邓祥兵2, 王自强2,()   
  1. 1. 610041 成都,四川大学华西医院胃肠外科;610041 成都,四川大学华西临床医学院
    2. 610041 成都,四川大学华西医院胃肠外科
  • 收稿日期:2017-04-16 出版日期:2017-08-25
  • 通信作者: 王自强
  • 基金资助:
    四川省科技厅科技支撑计划(No.2016SZ0043)

MDT strategy for liver and para-aortic lymph node oligometastasis in colorectal cancer

Chaoyang Gu1, Xiangbing Deng2, Ziqiang Wang2,()   

  1. 1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; West China School of Medicine, Sichuan University, Chengdu 610041, China
    2. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2017-04-16 Published:2017-08-25
  • Corresponding author: Ziqiang Wang
  • About author:
    Corresponding author: Wang Ziqiang, Email:
引用本文:

古朝阳, 邓祥兵, 王自强. 结直肠癌肝脏、腹主动脉旁淋巴结寡转移的MDT策略[J/OL]. 中华结直肠疾病电子杂志, 2017, 06(04): 330-335.

Chaoyang Gu, Xiangbing Deng, Ziqiang Wang. MDT strategy for liver and para-aortic lymph node oligometastasis in colorectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(04): 330-335.

结直肠癌是最常见的恶性肿瘤之一,发病率和死亡率均居所有肿瘤前列。转移是结直肠癌预后不佳的主要因素之一,其常见转移部位为肝、肺及淋巴结系统等,其中肝脏是结直肠癌血行转移最主要的靶器官之一。针对结直肠癌转移病灶,多学科综合诊疗(MDT),是治疗的最佳选择。而随着多学科诊疗的进展,结直肠癌"寡转移"逐渐被提出,寡转移是指肿瘤生物侵袭性较温和的一段时期,存在于局限性原发灶与广泛性转移之间的过渡阶段,转移瘤的数量有限且转移器官具有特异性。本文通过对2例结直肠癌同时性肝脏寡转移患者(其中一例伴同时性腹主动脉旁淋巴结转移)MDT治疗策略的分析与文献复习,就结直肠癌肝脏及孤立的腹主动脉旁淋巴结(PALN)寡转移的概念及诊治进展做一综述。

Colorectal cancer is one of the most common malignant tumors, the morbidity and mortality rank the forefront of cancers.Metastasis is one of the main factors of poor prognosis in colorectal cancer. The common metastatic sites are the liver, lung and lymph node system, and the liver is one of the most important target organ. For the colorectal cancer metastatic lesions, multidisciplinary team (MDT) is the best choice for treatment.With the progress of multidisciplinary diagnosis and treatment, colorectal cancer ″Oligometastasis″, was gradually raised. The oligometastasis refers to a period in which the tumor is less invasive and has a transitional stage between the primary lesion and the extensive metastasis, the number of metastatic lesions is limited and the metastatic organ is specific.In this study, the MDT treatment strategies of two cases of colorectal cancer patients with synchronous liver metastases (one case with synchronous para-aortic lymph node metastasis) are analyzed and the concept of liver and PALN oligometastasis in colorectal cancer and the progress of treatment are reviewed.

图2 肝脏MRI。图2A,2B分别示:病例一患者新辅助治疗后肝脏MRI显示肝脏转移灶大小约分别为:1.3 cm×0.9 cm,1.0 cm×0.75 cm
图4 肝脏MRI。图4A示:病例二患者新辅助化疗前肝脏MRI显示肝转移灶大小约为:3.9 cm×2.5 cm;图4B示:病例二患者新辅助化疗后肝脏MRI显示肝转移灶大小约为:2.6 cm×1.9 cm
表1 两病例特点比较
[1]
Arru M, Aldrighetti L, Castoldi R, et al.Analysis of Prognostic Factors nfluencing Long-term Survival After Hepatic Resection for Metastatic Colorectal Cancer[J]. World Journal of Surgery, 2008, 32(1):93–103.
[2]
Vibert E, Canedo L, Adam R. Strategies to treat primary unresectable colorectal liver metastases[J]. Semin Oncol, 2005, 32(6 suppl 8):33–39.
[3]
Kemeny N. Management of liver metastases from colorectal cancer[J]. Oncology (Williston Park), 2006, 20(10):1161-1176, 1179; discussion 1179-1180, 1185-1166.
[4]
Lau WY, Lai EC. Hepatic resection for colorectal liver metastases[J]. Singapore Med J, 2007, 48(7):635–639.
[5]
Taniai N, Akimaru K, Yoshida H, et al. Surgical treatment for better prognosis of patients with liver metastases from colorectal cancer[J]. Hepatogastroenterology, 2007, 54(78):1805–1809.
[6]
Arru M, Aldrighetti L, Castoldi R, et al. Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer[J]. World J Surg, 2008, 32(1):93–103.
[7]
Sharma S, Camci C, Jabbour N. Management of hepatic metastasis from colorectal cancers: an update[J]. J Hepatobiliary Pancreat Surg, 2008, 15(6):570-580.
[8]
Hellman S, Weichselbaum RR.Oligometastases[J]. J Clin Oncol, 1995, 13(1):8-10.
[9]
Benson AB, Venook AP, Bekaii-Saab T, et al. Rectal Cancer, Version 2.2015[J]. J Natl Compr Canc Netw, 2015, 13(6):719-728; quiz 728.
[10]
Weichselbaum RR. Hellman S. Oligometastases revisited[J]. Nat Rev Clin Oncol, 2011, 8(6):378-382.
[11]
Bentrem DJ, DeMatteo RP, Blumgart LH. Surgical therapy for metastatic disease to the liver[J]. Ann Rev Med, 2005, 56:139-156.
[12]
Abdalla EK. Commentary: Radiofrequency ablation for colorectal liver metastases : do not blame the biology when it is the technology[J]. Amer J Surg, 2009, 197(6):737-739.
[13]
Hur H, Ko YT, Min BS, et al. Comparative study of reseaction and radiofrequency ablation in the treatment of solitary colorectal liver metastases[J]. Amer J Surg, 2009, 197(6):728-736.
[14]
Reuter NP, Woodall CE, Scoggins CR, et al. Radiofrequency ablation vs. resection for hepatic colorectal metastasis : therapeutically equivaient?[J]. J Gastrointest Surg, 2009, 13(3):486-491.
[15]
Dexiang Z, Li R, Ye W, et al. Outcome of patients with colorectal liver metastasis: analysis of 1, 613 consecutive cases[J]. Ann Surg Oncol, 2012, 19(9):2860-2868.
[16]
Sharma S, Camci C, Jabbour N. Management of hepatic metastasis from colorectal cancers: an update[J]. J Hepatobiliary Pancreat Surg, 2008, 15(6):570-580.
[17]
Timmerman RD, Bizekis CS, Pass HI, et al. Local surgical, ablative, and radiation treatment of metastases[J]. Ca Cancer J Clin, 2009, 59(3):145-170.
[18]
Van der Voort van Zijp J, Hoekstra HJ, Basson MD. Evolving management of colorectal cancer[J]. World J Gastroenterol, 2008, 14(25):3956-3967.
[19]
Lochan R, White SA, Manas DM. Liver resection for colorectal liver metastasis[J]. Surgical Oncology, 2007, 16(1):33-45.
[20]
Adam R, Hoti E, Bredt LC. Oncosurgical strategies for metastatic liver cancer[J]. European Journal of Cancer Supplements, Cir Esp, 2011, 89(1):10-19.
[21]
Folprecht G, Gruenberger T, Bechstein WO, et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial[J]. Lancet Oncol, 2010, 11(1):38-47.
[22]
Adam R. Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases[J]. Ann Oncol, 2003, 14 Suppl 2:ii13-ii16.
[23]
Goldberg RM, Sargent DJ, Morton RF, et al. Randomized controlled trial of reduced-dose bolus fluorouracil plus leucovorin and irinotecan or infused fluorouracil plus leucovorin and oxaliplatin in patients with previously untreated metastatic colorectal cancer: a North American Intergroup Trial[J]. J Clin Oncol, 2006, 24(21):3347-3353.
[24]
Benoist S, Nordlinger B. Neoadjuvant treatment before resection of liver metastases[J]. Eur J Surg Oncol, 2007, 33(Suppl 2):S35-41.
[25]
Adam R, Bhangui P, Poston G, et al. Is perioperative chemotherapy useful for solitary, metachronous, colorectal liver metastases?[J]. Ann Surg, 2010, 252(5):774-787.
[26]
Matias M, Casa-Nova M, Faria M, et al.Prognostic Factors after Liver Resection for Colorectal Liver Metastasis[J]. 2015, 28(3):357-349.
[27]
Choi PW, Kim HC, Kim AY, et al.Extensive lymphadenectomy in colorectal cancer with isolated para-aortic lymph node metastasis below the level of renal vessels[J]. J Surg Oncol, 2010, 101(1):66-71.
[28]
Shibata D, Paty PB, Guillem JG, et al.Surgical management of isolated retroperitoneal recurrences of colorectal carcinoma[J]. Dis Colon Rectum, 2002, 45(6):795-801.
[29]
Min BS, Kim JS, Kim NK, et al.Extended lymph node dissection for rectal cancer with radiologically diagnosed extramesenteric lymph node metastasis[J]. Ann Surg Oncol, 2009 , 16(12):3271-3278.
[30]
Bae SU, Han YD, Cho MS, et al.Oncologic outcomes of colon Cancer patients with extraregional lymph node metastasis: comparison of isolated paraaortic lymph node metastasis with resectable liver metastasis[J]. Ann Surg Oncol, 2016, 23(5):1562-1568.
[31]
Gagnière J, Dupré A, Chabaud S, et al. Retroperitoneal nodal metastases from colorectal cancer: curable metastases with radicalretroperitoneal lymphadenectomy in selected patients[J]. Eur J Surg Oncol, 2015 , 41(6):731-737.
[32]
Wong JS, Tan GH, Teo MC.Management of para-aortic lymph node metastasis in colorectal patients: A systemic review[J]. Surgical Oncology, 25(2016) , 411-418.
[33]
Razik R, Zih FS, Haase E, et al.Long-term outcomes following resection of retroperitoneal recurrence of colorectal cancer[J]. Eur J Surg Oncol, 2014 , 40(6):739-476.
[34]
Takenoue T, Yamada Y, Miyagawa S, et al.Cisplatin-5-fluorouracil therapy with remarkable effect and 5-year survival for paraaortic lymph node metastases of rectal carcinoma in females: a case report[J]. Jpn J Clin Oncol, 1999, 29(11):582-586.
[1] 罗青杉, 梅海涛, 郝家领, 蔡锦锋, 周润楷, 温玉刚. 连接蛋白43通过调控细胞周期抑制结直肠癌的增殖机制研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 344-349.
[2] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[3] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[4] 施烨鑫, 马翔, 鲁明, 夏青城, 王鹏超, 宋青雨, 赵庆洪. 腹腔镜下结直肠肿瘤定位研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 463-466.
[5] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[6] 何慧玲, 鲁祖斌, 冯嘉莉, 梁声强. 术前外周血NLR和PLR对结肠癌术后肝转移的影响[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 682-687.
[7] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[8] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[9] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[10] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[11] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[12] 张蔚林, 王哲学, 白峻阁, 黄忠诚, 肖志刚. 利用TCGA数据库构建基于miRNA的结直肠癌列线图预后模型[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 381-388.
[13] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[14] 任佳琪, 刁德昌, 何自衍, 张雪阳, 唐新, 李文娟, 李洪明, 卢新泉, 易小江. 网膜融合线导向的脾曲游离技术在左半结肠癌根治术中的应用[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 362-367.
[15] 张迪, 王春霞, 张学东, 李发馨, 庞淅文, 陈一锋, 张维胜, 王涛. 梗阻性左半结直肠癌自膨式金属支架置入后行腹腔镜手术与开腹手术的短期临床疗效比较[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 375-380.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?