Clinical efficacy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy combined with hepatectomy in the treatment of colorectal peritoneal metastasis combined with liver metastasis

doi:10.3877/cma.j.issn.2095-3224.2022.01.011

Abstract

Abstract:

Objective

To determine the efficacy and safety of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) combined with hepatectomy in the treatment of colorectal peritoneal metastases (CRPM) combined with liver metastasis (LM).

Methods

Sixteen clinicopathological data of CRPM patients with isolated LM from June 2017 to June 2019 in Colorectal Surgery Department, Cancer Hospital Chinese Academy of Medical Sciences were collected retrospectively.

Results

There were six men and ten women present, with a median age of 62 years. All patients underwent CRS+HIPEC with concurrent liver resection, and the LM was completely removed. The median disease-free survival time was 9 months, and the median overall survival time was 25 months. The 1-year and 3-year overall survival rates were 75.0 and 37.0 percent, respectively, as were the 1-year and 3-year disease-free survival rates of 50.0 and 9.4 percent. Six cases (37.5%) had minor complications (Clavien-Dindo I~II), and four cases (25.0%) had major complications (III~IV).

Conclusions

CRS+HIPEC combined with simultaneous liver resection is safe and viable for patients with CRPM combined with isolated and totally resected LM, and it can also provide some survival improvements.

Key words: Colorectal neoplasms, Peritoneal metastasis, Liver metastasis, Hyperthermic intraperitoneal chemotherapy, Hepatectomy, Cytoreductive surgery

Yujuan Jiang, Sicheng Zhou, Jianjun Bi, Haipeng Chen, Wei Pei, Jianwei Liang, Qian Liu, Xishan Wang. Clinical efficacy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy combined with hepatectomy in the treatment of colorectal peritoneal metastasis combined with liver metastasis[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(01): 70-76.

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References 28

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序号	肝转移灶部位	肝切除术类型	HIPEC方案	CRS类型
1	左＋右叶	射频消融术	L-OHP	全子宫+盆腔转移灶切除术
2	右叶	肝段切除术	L-OHP+ZD1694+Lobaplatin	右半结肠＋腹腔转移灶切除
3	右叶	射频消融术	L-OHP+ZD1694+Lobaplatin	右半结肠+大网膜切除术
4	左＋右叶	肝转移瘤切除术	L-OHP	乙状结肠+双侧附件+大网膜+盆腔转移灶切除术
5	右叶	肝转移瘤切除术	L-OHP	直肠Hartmann术+盆腔腹膜切除术
6	右叶	肝段切除术	L-OHP+ZD1694+Lobaplatin	直肠Dixon术 +子宫双附件+盆腔转移灶切除术
7	右叶	肝段切除术	L-OHP+ZD1694	直肠Hartmann术 +双侧附件切除术
8	右叶	肝转移瘤切除术	L-OHP+ZD1694	右半结肠+脾切除术
9	右叶	肝转移瘤切除术	L-OHP+ZD1694+Lobaplatin	右半结肠+双侧附件+大网膜切除术
10	右叶	射频消融术	L-OHP+ZD1694+Lobaplatin	大网膜切除术+乙状结肠双腔造瘘术
11	右叶	肝段切除术	L-OHP+ZD1694+Lobaplatin	大网膜切除术+横结肠造瘘术
12	左叶	肝转移瘤切除术	L-OHP+ZD1694+Lobaplatin	直肠癌Hartmann术+盆腔转移灶切除术
13	左叶	肝转移瘤切除术	L-OHP	直乙交界+大网膜、阑尾、左侧卵巢切除
14	左叶	肝转移瘤切除术	L-OHP	左侧附件+大网膜+盆底腹膜切除术
15	左叶	肝转移瘤切除术	L-OHP+ZD1694+Lobaplatin	直肠乙状结肠+子宫双附件+大网膜切除术
16	左＋右叶	肝段切除术	L-OHP+ZD1694+Lobaplatin	右半结肠+回肠+盲肠+大网膜切除术

序号	肝转移灶部位	肝切除术类型	HIPEC方案	CRS类型
1	左＋右叶	射频消融术	L-OHP	全子宫+盆腔转移灶切除术
2	右叶	肝段切除术	L-OHP+ZD1694+Lobaplatin	右半结肠＋腹腔转移灶切除
3	右叶	射频消融术	L-OHP+ZD1694+Lobaplatin	右半结肠+大网膜切除术
4	左＋右叶	肝转移瘤切除术	L-OHP	乙状结肠+双侧附件+大网膜+盆腔转移灶切除术
5	右叶	肝转移瘤切除术	L-OHP	直肠Hartmann术+盆腔腹膜切除术
6	右叶	肝段切除术	L-OHP+ZD1694+Lobaplatin	直肠Dixon术 +子宫双附件+盆腔转移灶切除术
7	右叶	肝段切除术	L-OHP+ZD1694	直肠Hartmann术 +双侧附件切除术
8	右叶	肝转移瘤切除术	L-OHP+ZD1694	右半结肠+脾切除术
9	右叶	肝转移瘤切除术	L-OHP+ZD1694+Lobaplatin	右半结肠+双侧附件+大网膜切除术
10	右叶	射频消融术	L-OHP+ZD1694+Lobaplatin	大网膜切除术+乙状结肠双腔造瘘术
11	右叶	肝段切除术	L-OHP+ZD1694+Lobaplatin	大网膜切除术+横结肠造瘘术
12	左叶	肝转移瘤切除术	L-OHP+ZD1694+Lobaplatin	直肠癌Hartmann术+盆腔转移灶切除术
13	左叶	肝转移瘤切除术	L-OHP	直乙交界+大网膜、阑尾、左侧卵巢切除
14	左叶	肝转移瘤切除术	L-OHP	左侧附件+大网膜+盆底腹膜切除术
15	左叶	肝转移瘤切除术	L-OHP+ZD1694+Lobaplatin	直肠乙状结肠+子宫双附件+大网膜切除术
16	左＋右叶	肝段切除术	L-OHP+ZD1694+Lobaplatin	右半结肠+回肠+盲肠+大网膜切除术

项目	例数（n=16）	项目	例数（n=16）
年龄（岁）	62（36~73）	腹腔积液	7（43.7）
性别		新辅助治疗	7（43.7）
男	6（37.5）	术前实验室检查
女	10（62.5）	CEA（ng/mL）	39.3±76.6
BMI（kg/m²）	22.5±3.9	CA19-9（U/mL）	118.5±235.4
ASA分级		WBC（10⁹/L）	6.5±1.3
Ⅱ	13（81.3）	TBIL（mg/dL）	12.8±5.7
Ⅲ	3（18.8）	AST（IU/L）	19.8±7.9
腹部手术史	6（37.5）	ALT（IU/L）	20.2±15.3
原发灶部位		肝转移灶大小（cm）	2.0±1.3
升结肠	7（43.7）	肝转移灶部位
横结肠	1（6.2）	左叶	4（25.0）
乙状结肠	3（18.8）	右叶	9（56.2）
直肠	5（31.3）	累及两叶	3（18.8）

项目	例数（n=16）	项目	例数（n=16）
年龄（岁）	62（36~73）	腹腔积液	7（43.7）
性别		新辅助治疗	7（43.7）
男	6（37.5）	术前实验室检查
女	10（62.5）	CEA（ng/mL）	39.3±76.6
BMI（kg/m²）	22.5±3.9	CA19-9（U/mL）	118.5±235.4
ASA分级		WBC（10⁹/L）	6.5±1.3
Ⅱ	13（81.3）	TBIL（mg/dL）	12.8±5.7
Ⅲ	3（18.8）	AST（IU/L）	19.8±7.9
腹部手术史	6（37.5）	ALT（IU/L）	20.2±15.3
原发灶部位		肝转移灶大小（cm）	2.0±1.3
升结肠	7（43.7）	肝转移灶部位
横结肠	1（6.2）	左叶	4（25.0）
乙状结肠	3（18.8）	右叶	9（56.2）
直肠	5（31.3）	累及两叶	3（18.8）

项目	例数（n=16）
PCI		11.3±4.2
＜10		9（56.3）
10~19		7（43.8）
中位PCI		9.5（6~18）
CC评分
0/1		12（75.0）
2/3		4（25.0）
手术时间（min）		220.0±78.7
术中出血量（mL）		122.5±102.2
排气时间（天）		3.0±0.7
术后住院时间（天）		16.1±8.6
术后实验室检查
CEA（ng/mL）		15.0±31.8
CA19-9（U/mL）		23.7±26.3
WBC（10⁹/L）		8.1±3.0
TBIL（mg/dL）		13.1±7.7
AST（IU/L）		25.4±22.7
ALT（IU/L）		17.5±11.3
术后并发症
Clavien-Dindo Ⅰ/Ⅱ		6（37.5）
Clavien-Dindo Ⅲ/Ⅳ		4（25.0）
	心律失常	1（6.3）
	肠梗阻	1（6.3）
	腹膜炎	1（6.3）
	直肠阴道瘘	1（6.3）

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