Vol 28, No 4 (2023)

BACKGROUND: At the time of initial colorectal cancer diagnosis, synchronous metastases are found in 20–25% of patients. The medical approach, in which liver resection is performed as the first stage of treatment is called liver-first. The rationality of this approach is justified by elimination of the most prognostically significant tumor foci, which are hepatic metastases, with subsequent treatment of primary colorectal tumor.

AIM: To evaluate the immediate and long-term treatment results in patients with metastatic colorectal cancer, focused on surgical removal of synchronous liver metastatic foci as the first stage of treatment.

MATERIALS AND METHODS: A single-center, observational, prospective cohort study was carried out from February 2017 to June 2023 in the abdominal surgical department of the P.A. Herzen Moscow State Medical Institute — a branch of the National Medical Research Radiological Center (Moscow, Russia).

RESULTS: The study included 70 patients (37 men and 33 women). The treatment plan, according to the previously approved protocol, was carried out in 25 patients out of 70 (35.7%). Mean duration of the first stage was 235 min (125–328 min), mean blood loss volume 450 ml (100 ml–1300 ml). Mean hospitalization length was 17 bed days (12–21). The 30-day mortality rate was 12.8% (5 out of 39 patients). Overall, 1-year and 3-year survival rate after second stage of the treatment was 78% and 52%, respectively. At the same time, 1-year progression-free survival rate was 25%, and 3-year survival rate was 11%.

CONCLUSION: In rare clinical situations, when synchronous bilobar liver metastases are accompanied by an asymptomatic primary tumor, the best choice is to follow the liver-first protocol. However, it should be noted that not every patient at stage IV colorectal cancer can be a candidate for combined two-stage treatment, which is determined by somatic status and high risk of disease progression.

BACKGROUND: Every year more than 1 million new cases of colorectal cancer are diagnosed worldwide, with approximately 30% patients already having distant metastases. Colorectal cancer is often complicated, which makes chemotherapy challenging or, in some cases, impossible, therefore worsening the prognosis. As the first step, such patients need to undergo surgical treatment, in order to eliminate existing complications. However, what volume of surgery remains a discussion point among ongologists: a colostomy or a cytoreductive r2 resection to remove the primary tumor.

AIM: To analyze the results of complex treatment in patients with metastatic colorectal cancer and to optimize surgical treatment approaches.

MATERIALS AND METHODS: We conducted a study in Samara regional clinical Oncology dispensary (Samara, Russia), which included patients with metastatic colorectal cancer complicated by intestinal obstruction. Before treatment, all patients were examined according with current clinical standards. Subsequently, the patients were divided into two groups: the first group included patients who underwent cytoreductive surgery (r2 resection to remove the primary lesion due to the presence of colonic obstruction), and the second group included patients who underwent palliative surgery (colostomy or a bypass anastomosis in order to eliminate intestinal obstruction without removing the primary tumor).

RESULTS: We found that postoperative complications in patients who had undergone primary tumor removal were significantly more prevalent. At the same time, however, the number of complications at the stage of chemotherapy, combined with angiogenesis inhibitor therapy, was significantly greater than in the group of patients in whom primary lesion was not removed. Complications that arose during chemotherapy affected the number of chemotherapy cycles performed. Discontinuation of chemotherapy affected event-free and overall survival.

CONCLUSION: Timely identification and elimination of existing complications by removing the primary tumor focus before chemotherapy is an important component of an individual approach in order to develop treatment optimal tactics for patients with metastatic colorectal cancer.

This article addresses the issue of surgical treatment effectiveness in cases of disseminated melanoma. It is shown that disseminated melanoma can be divided into truly disseminated and oligometastatic processes, where distant metastases are resectable. Previously, surgical intervention was the treatment of choice for patients with resectable distant metastases, however, with the development of new therapeutic approaches, such as immune checkpoint inhibitors and targeted therapies, the role of surgery has become less straightforward. However, tumor burden reduction through surgical removal of metastatic lesions may enhance the immune response. Combined treatment, involving surgical intervention and systemic therapy, has emerged as a new approach in treatment of disseminated melanoma, improving efficacy and prognosis. The article emphasizes the need for further research to determine the optimal approach for treatment in this patient population.