Colorectal Liver Metastases. Aspects on Diagnosis and Surgical Treatment

Detta är en avhandling från Department of Surgery, Blekinge Hospital, S-374 80 Karlshamn, Sweden

Sammanfattning: Liver is the most common site of dissemination in colorectal cancer, and untreated liver metastases are associated with a poor prognosis. The main reason for trying to detect liver metastases early is that liver resection offers a chance for cure in selected patients. The sensitivity of alkaline phosphatases (ALP), carcinoembryonic antigen (CEA), computed tomography (CT), CT with arterial contrast (CTA), ultrasonography (US) and surgical assessment (SA) to detect clinically occult liver metastases in patients undergoing resection for colorectal cancer was 23, 56, 58, 69, 50, and 73 %, respectively. Five-year survival rate in 53 patients undergoing intensive follow-up (FU group) after colorectal resection and in 54 patients with no follow-up was 75 and 67 %, respectively, (p>0.05). CEA was the most sensitive indicator of recurrence. Two patients in the FU group were cured from tumour recurrences. The ability of fine-needle aspiration cytology (FNAC) to correctly classify a liver lesion as benign or malignant was 89 %, but the predictive value when FNAC showed no malignancy was only 27 %. The major complication to FNAC was implantation metastases which occurred in 3 %. Intraoperative ultrasonography (IOUS) provided new information in 38 % of 91 instances of planned liver resection when compared to preoperative CT and surgical assessment, and lead to changed surgical strategy in 13 %. IOUS predicted resectability in 97% of the operations. Five-year survival after liver resection for colorectal metastases in 68 patients operated 1971-84 and 43 patients operated 1985-1995 was 19 and 35 %, respectively (p=0.03) (25 % for all patients). Extrahepatic metastases, large number of blood transfusions and no free resection margin were associated with poor outcome. Five-year survival after hepatic re-resection was 29 %. Median survival in 57 patients with colorectal liver metastases treated with dearterialization was 1.1 years and 5-year survival was 0 %. There was no significant difference in survival between patients treated with temporary and repeated intermittent dearterialization.

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