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Objective:To study the detection rates of using different MRI sequences and enhanced CT in colorectal cancer liver metastasis (CRLM).Methods:The imaging data of CRLM patients who were treated at Peking University Third Hospital from March 2018 to September 2021 were retrospectively analyzed. Sixty-six CRLM lesions with a maximum diameter ≤10 mm were selected. Different MRI sequences such as T 1 weighted imaging (T 1WI), T 2 weighted imaging (T 2WI), diffusion weighted imaging (DWI), dynamic enhanced phase of MRI (MR-Dyn), gadolinium-etoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), enhanced hepatobiliary phase of MRI (HBP) and CT enhancement phase (CT-Dyn) were reviewed independently to determine whether the target lesions were detected. The pathological results were used as the gold standard. Paired chi-square test was used to compare the detection rate of CRLM in each group. Results:Among the 66 liver metastases, 15, 31, 55, 21, 56 and 20 were detected by T 1WI, T 2WI, DWI, MR-Dyn, HBP and CT-Dyn, respectively. Their detection rates were 22.7%, 47.0%, 83.3%, 31.8%, 84.8% and 30.3%, respectively. The detection rates of HBP and DWI were higher than those of T 2WI, MR-Dyn, CT-Dyn and T 1WI, respectively (all P<0.05). The detection rate of T 2WI was higher than that of MR-Dyn, CT-Dyn and T 1WI (all P<0.05). The detection efficiencies of non-contrast MRI and Gd-EOB-DTPA enhanced MRI for CRLM were highly consistent ( Kappa=0.745). Conclusions:The detection rates of HBP, DWI and T 2WI for CRLM were high. Non-contrast MRI could replace Gd-EOB-DTPA enhanced MRI for detection of large CRLM.
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The probability of developing liver metastases in patients with colorectal cancer is 40%-50%. Liver metastases remain an important adverse factor affecting long-term prognosis of colorectal cancer patients. Surgical resection of liver metastases is the only potentially curative treatment option. After comprehensive treatment, initially unresectable liver metastases might be converted to resectable tumors. This concept is known as conversion therapy. In this review, research status of conversion therapy in colorectal cancer liver metastases was summarized, providing updated concept of resectability, discussions on the assessment of tumor response and timing of operation, debates on the influence on tumor sidedness, and latest advancement in the treatment strategy of conversion therapy. Through analyzing existing problems, we hope to offer insights into possible progress in the future and provide references for the development of clinical practice.
Subject(s)
Humans , Biomedical Research , Colorectal Neoplasms/therapy , Combined Modality Therapy/methods , Hepatectomy , Liver Neoplasms/therapy , PrognosisABSTRACT
In recent years,the morbidity of colorectal cancer (CRC) has gradually increased,and trends to be younger.There are 1.2 million new patients suffering from CRC in the worldwide each year.Even undergoing radical mastectomy,there are still 25％ ～ 40％ of patients complicated with heterochronic liver metastasis simultaneously.The colorectal cancer liver metastasis (CRLM) has become one of the difficulties and the major cause of death,which is diagnosed in 20％ of patients at the same time of initial diagnosis.At present,the primary and metastatic cancer on liver resection is recognized as the only way to cure CRLM.In recent years,with the development of surgical technology,the normative use of peri-operative drugs,the collaboration of the mode of multidisciplinary team (MDT) and the development of the technology of targeted therapy,the survival rate of patients has been improved significantly.But the recurrence rate within 1 year is nearly 50 ％ after hepatectomy.Nearly 80 ％ of patients with CRLM missed opportunity for surgery when they were first diagnosed.Facing a huge group of CRLM,how to combine the patients' individual characteristics,the periodization of liver metastasis,the preoperative prognosis evaluation,the peri-operative adjuvant therapy and the directional treatment method etc.to form a systematic and effective therapeutic schedule has become the present focus attention,which still contains some outstanding issues.This article reviews the relevant progress.
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Objective To study laparoscopic microwave ablation (LWMA) in treating colorectal cancer liver metastases,and to evaluate its local efficacy and the factors influencing long-term survival.Methods A retrospective study was conducted on 24 patients with hepatic metastases after radical surgery of colorectal cancerin.These patients were treated with LWMA in Wenzhou People's Hospital from April 2012 to April 2017.The complete ablation,major complication,overall survival and disease-free survival rates were determined,and the factors influencing survival were analyzed.Results 71 tumor lesions in 24 patients were treated with LWMA.After the initial LWMA,complete tumor ablation was achieved in 70 lesions (98.6％).There were no serious adverse reactions and perioperative deaths.Conclusions LWMA had good short-term and long-term results.There were no serious adverse results.LWMA is an efficacious and safe treatment for patients with CRLM.
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Laparoscopic hepatectomy (LH) has been an incredible proliferation worldwide. many series have demonstrate that LH decreases intraoperative bleeding, postoperative compliceations and the duration of hospital stay. When compared with open hepatectomy(OP). Since the first LH was reported in 1992, near to 3000 cases have been reported,it's morbidity and mortality are 10. 5% and 0. 3% respectively. There are three terms should be used describe LH: pure laparoscopy, hand-assisted laparoscopy, and hybrid technique. In the beginning of LH, both resections were performed using the ultrasonic dissector and electrocautery,the operation included small wedge resection, liver cyst resection, and liver briopsy, however, while improvements in technology,as harmornic scalpel, endovasculer stapling devices, water jet, LigaSure, TissurLink, Habib etc. With increased experience, surgeons became holder and began to performe larger LH. But the keypoint of LH was use of portal inflow occlusion,and technique of paranchymal transection.