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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (03) : 236 -239. doi: 10.3877/cma.j.issn.2095-3224.2020.03.005

所属专题： 文献；

论著

中山医院结直肠癌MDT讨论治疗策略分析
朱德祥1, 韦烨1, 任黎1, 叶青海2, 王晓颖2, 崔越宏3, 刘天舒3, 周波4, 陈漪5, 王明亮6, 饶圣祥6, 王健7, 丁建勇8, 许剑民1,†(), 秦新裕1   
  1. 1. 200032　上海，复旦大学附属中山医院普外科
    2. 200032　上海，复旦大学附属中山医院肝外科
    3. 200032　上海，复旦大学附属中山医院肿瘤内科
    4. 200032　上海，复旦大学附属中山医院介入科
    5. 200032　上海，复旦大学附属中山医院肝内科
    6. 200032　上海，复旦大学附属中山医院放射诊断科
    7. 200032　上海，复旦大学附属中山医院放疗科
    8. 200032　上海，复旦大学附属中山医院胸外科
  • 收稿日期:2020-02-21 出版日期:2020-06-25
  • 通信作者: 许剑民
  • 基金资助:
    国家自然科学青年基金项目(No. 81602036); 上海市科学技术委员会项目(No. 17411951300)

Analysis of treatment strategy after colorectal cancer MDT discussion in Zhongshan Hospital

Dexiang Zhu1, Ye Wei1, Li Ren1, Qinghai Ye2, Xiaoying Wang2, Yuehong Cui3, Tianshu Liu3, Bo Zhou4, Yi Chen5, Mingliang Wang6, Shengxiang Rao6, Jian Wang7, Jianyong Ding8, Jianmin Xu1,†(), Xinyu Qin1   

  1. 1. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
    2. Department of Liver Surgery and Transplantation, Zhongshan Hospital, Fudan University, Shanghai 200032, China
    3. Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
    4. Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
    5. Department of Hepatic Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
    6. Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
    7. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
    8. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • Received:2020-02-21 Published:2020-06-25
  • Corresponding author: Jianmin Xu
  • About author:
    Corresponding author: Xu Jianmin, Email:
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朱德祥, 韦烨, 任黎, 叶青海, 王晓颖, 崔越宏, 刘天舒, 周波, 陈漪, 王明亮, 饶圣祥, 王健, 丁建勇, 许剑民, 秦新裕. 中山医院结直肠癌MDT讨论治疗策略分析[J/OL]. 中华结直肠疾病电子杂志, 2020, 09(03): 236-239.

Dexiang Zhu, Ye Wei, Li Ren, Qinghai Ye, Xiaoying Wang, Yuehong Cui, Tianshu Liu, Bo Zhou, Yi Chen, Mingliang Wang, Shengxiang Rao, Jian Wang, Jianyong Ding, Jianmin Xu, Xinyu Qin. Analysis of treatment strategy after colorectal cancer MDT discussion in Zhongshan Hospital[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(03): 236-239.

目的

分析结直肠癌多学科诊疗团队（MDT）讨论后制定的治疗策略。

方法

回顾性分析2010年7月至2019年2月复旦大学附属中山医院进行MDT讨论的结直肠癌患者的临床资料，对MDT讨论结果进行统计分析。

结果

结直肠癌MDT总计为1 953例结直肠癌患者进行4 535人次讨论制定个体化治疗方案。其中，553例患者肝转移灶和111例患者肺转移灶被认为可切除。另有261位最初不可切除的结直肠癌肝转移患者，在接受系统化疗联合分子靶向以及介入等综合治疗后，转化为可切除，建议接受肝转移灶切除手术。实际上总计772位结直肠癌患者接受肝转移灶切除，其中同时性肝转移患者有581例，而接受结直肠癌原发灶和肝转移灶同步切除的患者有248例。肝切除手术中仅有87例患者（11.3%）实施解剖性肝切除，绝大多数实施非解剖性肝切除。肝转移灶切除手术中联合射频消融的有62例（8.0%）。术后病理提示R1切除的有18位（2.3%）。

结论

复杂结直肠癌病例推荐行MDT讨论。扩展手术适应证、应用二步肝切除术、联合射频消融等局部毁损治疗可以扩大肝转移灶手术的适应人群。初始无法手术切除的患者，如状况耐受，建议给予强烈的个体化转化治疗，争取转化后手术切除。

关键词: 结直肠肿瘤, 多学科诊疗团队, 手术切除, 转化治疗
Objective

To explore the role of multidisciplinary team (MDT) in the diagnosis and treatment of patients with colorectal cancer.

Methods

A retrospective analysis of CRC patients who underwent MDT discussions from July 2010 to February 2019 at Zhongshan Hospital, Fudan University was conducted and analyzed.

Results

A total of 4 535 MDT discussions developed individualized treatment regimens for 1 953 patients with CRC. Among them, 553 patients with liver metastases and 111 with lung metastases were considered to be resectable. Moreover, 261 patients with initially unresectable colorectal liver metastases were converted to resectable after receiving comprehensive treatment. Actually a total of 772 patients underwent hepatectomy, including 581 patients with synchronous liver metastases, and 248 patients received simultaneous resection of primary colorectal cancer and liver metastases. Only 87 patients (11.3%) underwent anatomical hepatectomy, while the vast majority performed non-anatomical hepatectomy. Sixty-two patients (8.0%) underwent hepatectomy combined with intraoperative radiofrequency ablation. Postoperative pathology results revealed 18 (2.3%) cases of R1 resection.

Conclusion

MDT discussion is recommended for patients with complex CRC. Expanding surgical indications, applying two-step hepatectomy, and combination with radiofrequency ablation can expand the population who underwent metastases surgery. For patients with initially unresectable metastases, it is recommended to perform strong individualized conversion therapy for secondary surgical resection if fit.

Key words: Colorectal neoplasms, Multidisciplinary team, Surgical resection, Conversion therapy
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