Russian Journal of OncologyRussian Journal of OncologyРоссийский онкологический журнал1028-99842412-9119Eco-Vector4002110.17816/onco40021ArticlesСтатьиResearch ArticleExtensive liver resection with preoperative chemotherapy for colorectal metastases with high risk of complicationsОбширные резекции печени с предоперационной химиотерапией по поводу метастазов колоректального рака с высоким риском осложненийPatyutkoYu. IПатюткоЮ. ИMamontovK. GМамонтовКонстантин Григорьевич

канд. мед. наук, зав. отд-нием рентгенохирургических методов диагностики и лечения злокачественных опухолей

mamontovkg@mail.ruKotelnikovA. GКотельниковА. ГPonomarenkoA. AПономаренкоА. АLazarevA. FЛазаревА. ФN.N. Blokhin Russian Cancer Research Center under the Russian Academy of Medical SciencesФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» РАМНRussian FederationАлтайский филиал ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» РАМН2Altai branch of N.N. Blokhin Russian Cancer Research Center under the Russian Academy of Medical SciencesФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» РАМНN.N. Blokhin Russian Cancer Research Center under the Russian Academy of Medical SciencesФГУ «Государственный научный центр колопроктологии» РосмедтехнологийState Scientific Center of ColoproctologyАлтайский филиал ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» РАМНRussian Federation2Altai branch of N.N. Blokhin Russian Cancer Research Center under the Russian Academy of Medical Sciences15042014192NO2 (2014)№2 (2014)41122072020Copyright ©; 2014, Eco-VectorCopyright ©; 2014, ООО "Эко-Вектор"2014Eco-VectorООО "Эко-Вектор"https://rjonco.com/1028-9984/article/view/40021

Objective: to study influence of preoperative chemotherapy on postoperative complications rate. Material and methods: an analysis of 455 cases of extensive liver resection. 229 (56%) patients didn’t receive neoadjuvant chemotherapy, 176 (44%) - received preoperative chemotherapy. 216 (53%) patients had bilobar lesions, 156 (39%) - had multiple metastases, 168 (42%) - had synchronous metastases, 237 (58%) - had metachronous metastases. 60 (15%) patients in addition to liver lesions, had been resected for extrahepatic metastases. Results: bevacizumab inckusion to preoperative regional chemotherapy did not lead to increase of postoperative complication rate. Conclusion: Postoperative complication rate didn’t significantly differ in all groups of treatment, regardless of liver resection volume. Extension of liver resection from standard hepatectomy to extensive, leads to statistically significant increase of acute hepatic failure. Acute hepatic failure takes the first place among complications (21%).

Цель - изучить влияние предоперационной химиотерапии на частоту основных послеоперационных осложнений. Материал и методы. Проведен сравнительный анализ результатов 405 обширных резекций печени: после хирургического лечения - 229 (56%) больных, с предоперационной химиотерапией - 176 (44%) больных. Билобарные метастазы - 216 (53%), множественные - 156 (39%), синхронные - 168 (42%), метахронные - 237 (58%) наблюдений. У 60 (15%) больных наряду с метастазами в печени имелись внепеченочные метастазы, которые были удалены. Результаты. Включение бевацизумаба в состав предоперационной регионарной химиотерапии не привело к повышению послеоперационных осложнений. Заключение. Уровень осложнений после обширных резекций печени независимо от характера операций в группах лечения достоверно не различается. При увеличении объема операции от стандартной к расширенной гемигепатэктомии независимо от лечения достоверно увеличивается частота острой печеночной недостаточности. Ведущее место среди осложнений в группах лечения занимает острая печеночная недостаточность - 21%. Наибольшая частота острой печеночной недостаточности в сравниваемых группах наблюдается в группе с предоперационной регионарной химиотерапией.

colorectal cancer metastasespreoperative chemotherapycomplicationsметастазы колоректального рака в печенипредооперационная химиотерапияосложненияBoyle P., Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann. Oncol. 2005; 16 (3): 481-8. doi:10.1093/annonc/mdi098. Accessed 5.16.07.Давыдов М.И., Аксель Е.М. Статистика злокачественных новообразований в России и страх СНГ. Вестник РОНЦ им. Н.Н. Блохина. 2010; 21 (прил. 1): 59.Laweus D., Taylor I. Chemotherapy for colorectal cancer - an overview of current management for surgeons. Eur. J. Surg. Oncol. 2005; 31 (9) 932-41.de Gramont A., Boni C., Navarro M. et al. Oxaliplatin leucovorin and fluorouracil in the adjuvant treatment of stage II and stage III colorectal cancer: efficacy results with a median follow-up of 4 years. In: Gastrointestinal Cancer Symposium, 2005: Proceedings. 2005: 167.Abdalla E.K., Adam R. et al. Improving respectability of hepatic colorectal metastases: Expert consensus statement. Ann. Surg. Oncol. 2006; 13 (10): 1271-80.Патютко Ю.И. Хирургическое лечение злокачественных опухолей печени. М.: Практическая медицина; 2005.Clavien P.A., Petrovsky H. et al. Strategies for safer liver surgery and partial liver transplantation. N. Engl. J. Med. 2007; 356: 1545-59.Tournigand C., Andre T., Achille E. et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: A randomized GERCOR study. J. Clin. Oncol. 2004; 22: 229-37.Falcone A., Ricci S., Brunetti I. et al. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J. Clin. Oncol. 2007;.25 (13): 1670-6.Lievre A., Bachet J.B., Boige V. et al. KRAS mutation as an independent prognostic factor in patients with advanced colorectal cancer treatment with cetuximab. J. Clin. Oncol. 2008; 26: 374-9.Nakamura S., Yokoi Y., Suzuki S. et al. Results of extensive surgery for liver metastases in colorectal carcinoma. Br. J. Surg. 1992; 79: 35-8.Zacharias T., Jaeck D., Oussoultzoglou E. et al. First and repeat resection of colorectal liver metastases in elderly patients. Ann. Surg. 2004; 240: 858-65.Fernandez F.G., Ritter J., Linehan D.C. et al. Effect of steato hepatitis associated with irinotecan or oxaliplatin pre-treatment on respectability of hepatic colorectal metastases. J. Am. Coll. Surg. 2005; 200: 845-53.Figueras J., Valls C., Rafecas A. et al. Resection rate and effect of postoperative chemotherapy on survival after surgery for colorectal liver metastases. Br. J. Surg. 2001; 88: 980-5.Bijelic L., Yan T.D., Sugarbaker P.H. Failure analysis of recurrent disease following complete cytoreduction and perioperative intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer. Ann. Surg. Oncol. 2007; 14 (8): 2281-8.Kato T., Yasui K., Hirai T. et al. Therapeutic results for hepatic metastases of colorectal cancer with special reference to effectiveness of hepatectomy: analysis of prognostic factors for 763 cases recorded at 18 institution. Dis. Colon. Rect. 2003; 46: 22-31.Tomlinson J.S., Jarnagin W.R., DeMatteo R.P. et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J. Clin. Oncol. 2007; 25 (29): 4575-80.Yan B., Clingan Ph., Morris D. Hepatic cryotherapy and regional chemotherapy with or without resection for liver metastases from colorectal carcinoma. How many are too many? Am. Cancer Soc.; 2003.Adams R.B., Haller D.G., Roh M.S. Improving respectability of hepatic colorectal metastases: expert consensus statement. Ann. Surg. Oncol. 2006; 13: 1271-80.Cioni D., Bartolozzi C., eds. Focal liver lesions detection, characterization, ablation. Berlin; Heidelberg: Springer-Verlag; 2005.Malafosse R., Penna C., Sa Cunha A., Nordlinger B. Surgical management of hepatic metastases from colorectal malignancies. Ann. Oncol. 2001; 12 (7): 887-94.Adam R., Hagopian E.J., Linhares M. et al. A comparison of percutaneus cryosurgery and percutaneus radiofrequency for unresectable hepatic malignancies. Arch. Surg. 2002; 137: 1332-9.Colucci G., Gebbia V., Paoletti G. et al. Phase III randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer: a multicenter study of the Gruppo Oncologico Dell’Italia Meridionale. J. Clin. Oncol. 2005; 23 (22): 4866-75.Van Cutsen E., Tabernero J., Lakomy R. et al. Intravenous (IV) aflibercept versus placebo in combination with irinotecan /5-FU (FOLFIRI) for second line treatment of metastatic colorectal cancer (MCRC): results of a multinational phase III trail (EFC 10262-VLOURE). Ann. Oncol. 2011; 22 (Suppl): 18.Zarate R., Rodriguez J. et al. Oxaliplatin irinotecan and capecitabine as first-line treatment metastatic colorectal cancer(mCRC): a dose-finding study and pharmacogenomics analysis. Br. J. Cancer. 2010; 102 (6): 987-94.Karoui M., Penna C., Amin-Hashem M. et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann. Surg. 2006; 243: 1-7.Vauthey J.N., Pawlik T.M., Ribero D. et al. Chemotherapy regiment predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J. Clin. Oncol. 2006; 24 (13): 2065-72.Gruenberger B., Scheithauer W., Tamandl D. et al. Effectiveness of neoadjuvant chemotherapy including bevacizumab in patients with resectable colorectal cancer liver metastases. In: Meeting Proceedings 43rd ASCO. 2007; Abstr. 4060.