Surgical Treatment of Colorectal Cancer Metastases
Introduction. Colorectal metastatic liver tumors are the most common secondary liver tumors. During life, the liver metastases will develop either as synchronous or metachronous carcinomas in half of the total number of patients. At the time of the diagnosis, in approximately 25% of patients with colorectal cancer diagnosis, the presence of secondary deposits in the liver was observed, and additional 25% of patients were to develop metastases within fi ve years. Aim of the study. The objective was to demonstrate that anatomic resections of the liver present the method of choice in surgical treatment of colorectal liver metastases, when compared to metastasectomy. Patients and methods. The study included 70 patients, divided into two groups. Among the patients from the fi rst group, metastasectomy, which was consisted of the removal of metastases and the surrounding liver parenchyma no more than 1cm with the usage of Kelly-clysis technique or Ligasure device, was performed. In patients from the second group, anatomic resection of the liver was performed upon which metastases were removed and the associated anatomical segment or section, that is, half of the liver depending on the number and localization of metastases. Results. The average overall survival values for the fi rst group was 36 months with a standard deviation of 4.8 months. The average overall survival in patients from the second group was 36 months with a standard deviation of 2.6 months. The average value of disease-free survival in the fi rst group was 18 months with a standard deviation of 2.22 months. In the second group, the average disease-free survival was 22 months with a standard deviation of 0.74 months. Conclusion. Overall survival in both types of operation was identical, and the average overall survival was 36 months. Disease-free interval in the anatomical resection was 22 months, while it was 18 months in metastasectomy. From all the above mentioned, it can be concluded that surgery is a fundamental and irreplaceable method in the treatment of liver metastases of colorectal cancer. Key words: liver, metastasis, metastasectomy, anatomical resection (Scr Med 2016:47:7-10) & ' ( ) * + , * . / . 0 1 2 3 2 , 2 1 , 4 , * 5 , + * 6 7 8 ) 5 * 5 , 9 : ; + + 5 ; + < = > ? @ A A , B A ; @ 7 ) . 5 < / 9 + : 8 Scripta Medica Vol. 47 • No 1 • April 2016. • www.scriptamedica.com Introduction C D E D F G H I J E H J K H G F L M I N G O D M I H D O O D K P J M I F D L K I G M I L K J E O J E L P K J K I I Q O D F I N J I L M J E M D I N G O D M I H D O O D K E L R G F I Q S O D F O G I J M I J M G M T U V I I N G I L O G D W I N G X L J P K D M L M Y L K J Z Z F D [ L S O J I G E \ ] ^ _ D W Z J I L G K I M ` L I N H D E D F G H I J E H J K H G F X L J P K D M L M Y I N G Z F G M G K H G D W M G H D K X J F \ X G Z D M L I M L K I N G E L R G F ` J M D a M G F S R G X Y J K X J X X L I L D K J E ] ^ _ D W Z J I L G K I M ` G F G I D X G R G E D Z O G S I J M I J M G M ` L I N L K b R G \ G J F M T c d N G b F M I E L R G F F G M G H I L D K W D F H D S E D F G H I J E E L R G F O G I J M I J M G M ` J M Z G F W D F O G X a \ C J I G E E L K e f g h T i L I N I N G L O Z F D R G O G K I D W M Q F P L H J E I G H N K L j Q G M Y L K I F D X Q H I L S D K D W K G ` H \ I D M I J I L H M J K X F G X Q H I L D K D W I N G F G M G H I L D K O J F S P L K I D E G M M I N J K e H O Y I N G J Z Z E L H J I L D K D W L K I G F R G K I L D K J E F J S X L D E D P \ Y Z D F I J E R G K D Q M G O a D E L k J I L D K Y J E E D ` G X I N G I F J K M W G F D W Z J I L G K I M W F D O I N G P F D Q Z ` L I N Q K F G M G H I J a E G I Q O D F M I D P F D Q Z ` L I N F G M G H I J a E G D K G M T d N G J L O D W I F G J I O G K I L M M Q F S P L H J E F G O D R J E D W J E E O G I J M I J M I J I L H I Q O D F M L K I N G E L R G F Y a G S H J Q M G I N G G [ Z G F L G K H G L K X L H J I G M I D I N G b R G S \ G J F M Q F R L R J E D W ] ^ S l h _ D W I N G D Z G F J I G X Z J I L G K I M T c m h _ D W H D K M G F R J I L R G E \ I F G J I G X Z J I L G K I M ` L I N O G I J M I J M G M X D K D I M Q F R L R G J \ G J F T n o G I J M I J M G H I D O L G M Z F G M G K I I N G P F D Q Z D W K D K J K J I D O L H F G S M G H I L D K M Q F P G F L G M ` N G F G I N G L K I G F M G H I L D K D W I N G N G Z J I L H Z J F G K H N \ O J ` L I N L K h T ^ S e H O D W I N G O G I J M I J M G M L M Z G F W D F S O G X ` L I N I N G Q M J P G D W p G E E \ S H F \ M L M D F q L P J M Q F G I G H N K L j Q G T V K J I D O L H J E E L R G F F G M G H I L D K M J F G a J M G X D K I N G Z F L K H L Z E G M D W M G P O G K I J E J K X M G H I D F J K J I D O \ D W I N G E L R G F T d N G G [ I G K I D W J K J I D O L H J E M Q F P G F \ L K H E Q X G M M G P O G K I G H D O L G M Y a L M G P O G K S I G H I D O L G M Y M G H I L D K G H I D O L G M J K X N G O L N G Z J I G H I D O L G M T Aim of the study d D G M I J a E L M N ` N G I N G F J K J I D O L H F G M G H I L D K D W I N G E L R G F L M I N G O G I N D X D W H N D L H G L K M Q F P L H J E I F G J I O G K I D W H D E D F G H I J E E L R G F O G I J M I J M G M Y ` N G K H D O Z J F G X I D O G I J M I J M G H I D O \ Y J M ` G E E J M I D O D K L I D F I N G X L M I J K H G L K X L M G J M G S W F G G I L O G J K X D R G F J E E M Q F R L R J E T Patients and methods d N G F G M G J F H N N J X I N G H N J F J H I G F D W J F G I F D M Z G H I L R G S Z F D M Z G S H I L R G M I Q X \ T d N G M Q F R G \ ` J M H D K X Q H I G X L K I N G r K L R G F M L I \ C E L K L H J E C G K I G F D W s J K t J q Q u J T d N G M I Q X \ H D R G F G X I N G Z G S F L D X W F D O v J K Q J F \ ] h h m I D v J K Q J F \ ] h e g T d N G M I Q X \ ` J M H D K X Q H I G X D K m h Z J I L G K I M Y X L R L X G X L K I D I ` D P F D Q Z M w P F D Q Z V J K X s x T C F L I G F L J W D F L K H E Q M L D K L K I N G M I Q X \ ` G F G F G M Z D S K X G K I M ` N D ` G F G I G H N K L H J E E \ J a E G I D a G I J u G K H J F G D W a \ M Q F P L H J E O G I N D X D W O G I J M I J M G H I D O L G M J K X a \ O G I N D X D W J K J I D O L H J E F G M G H I L D K M T o G I J M I J I L H X L M G J M G ` J M E D H J E L k G X D K E \ L K I N G E L R G F T d N G b F M I P F D Q Z D W F G M Z D K X G K I M y z { ^ w P F D Q Z V x Q K S X G F ` G K I M Q F P L H J E O G I J M I J M G H I D O L G M D W I N G I Q O D F J K X I N G M G H D K X P F D Q Z y z { ^ w P F D Q Z s x Q K X G F ` G K I J K J I D O L H J E F G M G H I L D K D W I N G I Q O D F T | K I N G P F D Q Z V Z J I L G K I M Y O G I J M I J M G H I D O \ Y ` N L H N ` J M H D K S M L M I G X D W F G O D R L K P O G I J M I J M G M J K X M Q F F D Q K X L K P E L R G F Z J S F G K H N \ O J K D O D F G I N J K e H O ` L I N I N G Q M J P G D W p G E L S H F \ M L M I G H N K L j Q G D F q L P J M Q F G X G R L H G Y ` J M Z G F W D F O G X T | K P F D Q Z s Z J I L G K I M Y J K J I D O L H F G M G H I L D K D W I N G E L R G F ` J M Z G F W D F O G X Q Z D K ` N L H N O G I J M I J M G M ` G F G F G O D R G X J K X I N G J M M D H L J I G X J K J I D O L H J E M G P O G K I D F M G H I L D K Y I N J I L M Y N J E W D W I N G E L R G F X G Z G K X L K P D K I N G K Q O a G F J K X E D H J E L k J I L D K D W O G I J M I J M G M T d N G W D E E D ` L K P M Q F P L H J E J Z Z F D J H N G M ` G F G Q M G X } O G X L J E Y v L K H L M L D K J K X o J u Q H N E J Z J F D I D O \ T V W I G F I N G D Z G K L K P Y ` G J H H G M M G X I D I N G O D a L E L k J I L D K D W I N G E L R G F Y W D E E D ` G X a \ L K S I F J D Z G F J I L R G Q E I F J M D K D P F J Z N \ w | ~ r V x Y ` N L H N Z F D R L X G X I N G X G I G H I L D K D W I N G Z F G H L M G I Q O D F Z D M L I L D K T q L R G F F G M G H I L D K ` J M Z G F W D F O G X J I F G X Q H G X H G K I F J E R G K D Q M Z F G M M Q F G C w h S ^ H O ] h x Y ` L I N I N G Z J I L G K I L K d F G K X G S E G K a Q F P Z D M L I L D K T J F G K H N \ O J I F J K M G H I L D K a G P J K ` L I N X L J I N G F O \ I J P D W F G M G H I L D K E L K G Y ` N L E G I N G M G H I L D K D W Z J S F G K H N \ O J ` J M Z G F W D F O G X a \ q L P J M Q F G D F p G E E \ S H F \ M L M I G S H N K L j Q G T s L E L D S R J M H Q E J F M I F Q H I Q F G M ` G F G I J u G K H J F G D W ` L I N H E L Z M J K X R J M H Q E J F M Q I Q F G M T Results d N G D Q I H D O G M D W I N G G [ J O L K G X M J O Z E G D W D R G F J E E M Q F R L S R J E a J M G X D K p J Z E J K S o G L G F H Q F R G M W D F Z J I L G K I M W F D O I N G P F D Q Z V ` N D Q K X G F ` G K I O G I J M I J I G H I D O L G M Y I N G O G X L J K D R G F J E E M Q F R L R J E ` J M { l O D K I N M ` L I N J M I J K X J F X X G R L J I L D K D W g T O D K I N M J K X J D K G S \ G J F Y I ` D S \ G J F J K X I N F G G S \ G J F M Q F R L R J E ` J M ^ T { _ Y l T { _ J K X ^ h _ T w C N J F I e T x d N G J R G F J P G D R G F J E E M Q F R L R J E L K P F D Q Z s Z J I L G K I M Y ` N D Q K S X G F ` G K I I N G J K J I D O L H J E M Q F P G F \ Y ` J M { l O D K I N M ` L I N J M I J K X J F X X G R L J I L D K D W ] T l O D K I N M J K X J D K G S Y I ` D S J K X I N F G G S \ G J F M Q F R L R J E ` J M f T { _ Y l m T ^ _ J K X ^ h _ T Chart 1. Medial overall survival V W I G F I N G M I J I L M I L H J E H D O Z J F L M D K M D W p J Z E J K S o G L G F H Q F R G M D W D R G F J E E M Q F R L R J E a \ o J K I G E S C D [ I G M I w ] z h T e l m Z z 9 V. ŠKRBIĆ, M. SIMATOVIĆ, J. ĐERI, G. JANJIĆ, S. MIHAJLOVIĆ h T l { x Y L I H J K a G H D K H E Q X G X I N J I I N G F G ` J M K D M I J I L M I L H J E E \ M L P K L b H J K I X L G F G K H G w Z h T h ^ x a G I ` G G K I N G M I Q X \ P F D Q Z M V J K X s ` N G K L I H D O G M I D D R G F J E E M Q F R L R J E T d N G O G X L J K R J E Q G D W X L M G J M G S W F G G M Q F R L R J E L K I N G P F D Q Z V ` J M e O D K I N M ` L I N J M I J K X J F X X G R L J I L D K D W ] T ] ] O D K I N M Y J D K G S \ G J F