Chzhao Alexey V, Ionkin Dmitry A*, Olifir Anna A, Vishnevsky Vladimir A, Zhavoronkova Olga I, Stepanova Yulia A, Karelskaya Natalia A, Zemskov Vladimir M and Kozlova Maria N
Department of Surgery, AV Vishnevsky National Medical Research Center of Surgery, RussiaFulltext PDF
Relevance: Colorectal Cancer (CRC) is one of the most common of the detection among malignant tumors. More than 80% of patients with metastases of the CRC to the liver are unsuitable for radical surgical treatment. It is this category of patients that shows the application of local thermal destruction methods. Aim: Improving the life quality, and increase life expectancy (in combination of chemotherapeutic treatment) in patients with metastatic of colorectal cancer in the liver (CLM). Materials and Methods: Cryodestruction has been performed in 24 patients with CLM. There were 11 women, 13 men. The median age was 56.3+4.5 years. "The size of the tumors in the liver was 1.5 cm to 9 cm, the number of tumors-from 1 to 10 (4 ± 3). The target temperature: -186ºС. Exposure time: 3 min to 5 min. Radiofrequency Ablation (RFA) in a combination of cryodestruction was performed in 3 patients, Cryo + liver resection-in 7, a combination of liver resection + RFA + Cryoin 5 patients. Open intraoperative RFA and percutaneous RFA were performed in 20 patients, combination of liver resection and RFA in 16 patients. All patients subsequently underwent adjuvant chemotherapy, supplemented with regional chemo embolization in 9 cases. Results: Life-threatening complications in postoperative period has been developed in 2 (8.4%) patients: intra-abdominal bleeding in 1 (4.2%) case, and multiple organ failure resulted in death on the 47th day after the intervention (liver resection+Cryo+RFA) in 1 (4.2%). Postoperative morbidity also includes biliary fistula in 2 (8.3%) patients, ascites - in 7 (29.6%), pleural effusion-in 6 (25%), pneumonia-in 2 (8.3%). Complete pain and right upper abdominal discomfort reduction after the procedure were observed in 40%, significant pain reduction - in 20% of patients. Median survival was 12.0+4 months for Cryo only, 11.0+4 months for RFA only, 7.6 +4 months for Cryo in combination of RFA, 13.5+5 months (p<0.05) for Cryo in combination with liver resection, 18.5+6 months (p<0.05) for liver resection in combination with other methods of local destruction (RFA, Cryo). Conclusion: Combination of different methods of local thermal destruction in case of unresectable CLM improves the quality of life and with adjuvant chemotherapy could prolong survival rates.
Local thermal destruction; Cryo destruction; RFA; Colorectal cancer liver metastases
Chzhao Alexey V, Ionkin Dmitry A, Olifir Anna A, Vishnevsky Vladimir A, Zhavoronkova Olga I, Stepanova Yulia A, et al. Combination of Liver Resection with Methods of Local Thermal Destruction in the Treatment of Metastases of Colorectal Cancer in the Liver. Clin Surg. 2019; 4: 2605.