"Intestinal" short words. Professor Chen Gong case sharing: "Knowing the fate of god, do our best" b-type colon cancer with liver metastasis one case.

Colorectal cancer is one of the most common malignant tumors in China, and surgical treatment is one of the most important methods.the oncology department of yimaitong invited Professor Chen Gong's team of cancer prevention and treatment center of Sun Yat sen University to set up a special column called "short talk of bowel talk", which will be updated one after another from now on to convey the latest research progress, the most cutting-edge diagnosis and treatment ideas, and the most practical clinical experience to each reader. Please note! At present, surgical resection is the main means to achieve long-term survival in patients with liver metastases from colorectal cancer (crlm).however, at the initial diagnosis, only about 20% of patients with liver metastases are resectable, and about 20-40% of the remaining patients can be converted to resectable under today's powerful chemotherapy regimen.in this issue, Professor Chen Gong's team shared the diagnosis and treatment process of a case of sigmoid colon cancer with liver metastasis.main complaint: the patient, a 55 year old man, went to the local hospital for physical examination and found liver space occupying in June 2019 due to changes in stool characteristics and emaciation.past history: healthy, no heart disease, diabetes, hypertension; no allergic history; elder sister suffering from breast cancer.pathological and imaging examination: in June 2019, the electronic colonoscopy showed a sigmoid colon tumor, which was about 20-22cm away from the anus under the colonoscopy, which was three-quarters around the cavity, with uneven surface and cauliflower shape, which was easy to bleed.pathological results showed adenocarcinoma (sigmoid colon).MMR immunohistochemistry showed that microsatellite was stable, KRAS and barfnras were negative.for further treatment, the pathological consultation of our hospital showed moderately differentiated adenocarcinoma (sigmoid colon).physical examination: ln; anal examination: 7cm into the anus, no tumor was touched, and no blood stain was found after fingertip withdrawal.on July 09, 2019 in our hospital, Mr plain scan and enhancement showed that the liver morphology was abnormal, the proportion of right lobe increased, and its contour was not smooth.there are several nodules and masses in the left and right lobes of the liver, the larger one is located in S7, the range is about 81mm × 56mm, the boundary is not clear, multiple liver metastases are considered.liver biopsy in our hospital on July 19, 2019 showed that: (liver tumor puncture) no liver tissue was found in the liver biopsy under the microscope, and the dysplastic fibrous tissue showed adenoid or cribriform infiltration with necrosis, and the morphology was in line with moderately differentiated adenocarcinoma. Combined with the history and immunohistochemical results, it was prone to liver metastasis of intestinal adenocarcinoma. Immunohistochemical results: CK20 (partial +), CDX2 (+), Satb2 (partial +), CK7 (-), CK19 (+), heppar1 (-).CT examination before chemotherapy showed that sigmoid colon was thickened and soft tissue mass was formed locally, so sigmoid colon cancer was considered.small mesenteric lymph nodes of sigmoid colon should be considered for metastasis.diagnosis: sigmoid colon cancer, multiple liver metastases treatment: enter the trice clinical trial on July 16, 2019.from July 19, 2019 to October 28, 2019, folfoxir + ebitux regimen was given for 7 courses of chemotherapy smoothly. After 4 courses of chemotherapy, CT and MR were reexamined to evaluate the efficacy of PR.the diagnosis of pelvic CT plain scan and enhanced examination on January 6, 2020: the sigmoid colon liver metastasis was reexamined after chemotherapy, compared with 2019-11-30 CT: the sigmoid colon intestinal wall thickening is not obvious.the mesenteric lymph nodes of sigmoid colon have little change compared with the previous ones.multiple intrahepatic lesions, considering metastasis, the change is not obvious.T9 / 10 intervertebral disc calcification.the dense shadow of spinous process of the C7 vertebral body was seen on the scanning plane, which was similar to that before considering the possibility of bone island.after consultation, Professor Zheng Yun of hepatobiliary Department suggested that liver metastases should be resected by operation.operation: laparoscopic sigmoid colon resection + liver metastasis resection + microwave ablation of liver metastasis.the patients took the font position and carried out routine disinfection and towel laying.after the establishment of pneumoperitoneum, trocar was placed to explore the abdominal and pelvic cavity. Two metastatic tumors were found on the surface of the liver, gray and hard. No obvious planting nodules were found in the pelvic floor and abdominal cavity.the tumor is located in sigmoid colon, the surface of the intestinal tube where the swelling bottle is located can be seen, and the tumor can be seen to adhere closely to the peritoneum of the posterior bladder wall.they were given "laparoscopic sigmoid colon resection + liver metastasis resection + microwave ablation". The operation process was smooth, the intraoperative blood loss was 50ml, and the anesthesia was satisfactory. After checking the instruments, the drainage tube was placed into the pelvic cavity, and the patient returned to the ward safely.specimen anatomy: intestinal tumor, size 4cm × 3cm × 3cm, hard, located in the whole colon, infiltrating the intestinal wall, shape infiltration, mucosal ulcer, invasion of serosa, lymphadenectasis (central group, middle group, para intestinal group), the lower pole was 5cm away from the distal margin, the upper pole was 15cm away from the proximal margin, and the gross margin was negative.specimen: a segment of sigmoid colon, the tumor size is about 3 * 4cm, hard, limited movement, upper margin 15cm, lower margin 10cm, liver S2, s, S4, a total of 5 tumors.Prof. Chen Gong: case review and comments: the patient was diagnosed with multiple liver metastases of sigmoid colon cancer in July 2019, and the initial stage was absolutely inoperable. The patient was wild and left half of Ras / BRAF. Therefore, he was recommended to participate in the trice study of Professor Li Yuhong, cancer prevention and treatment center of Sun Yat sen University. Folfoxiri + ebitux was treated for 10 cycles, and the curative effect was excellent.after discussion of MDT, it is suggested that surgery combined with other local treatment should be carried out to strive for ned. due to the epidemic situation, the operation was postponed to February 28. Combined with intraoperative ultrasound, a total of 23 lesions were found, 18 lesions were ablated by microwave and 5 lesions were removed. due to the shortage of blood supply in the blood bank during the epidemic period (the patient only applied for 2U of blood), ablation was used for some lesions with high risk of resection, which took nearly 7 hours. the treatment of synchronous liver metastasis from colorectal cancer is a complex system engineering, and it is also the best model for testing and practicing MDT in a hospital. patients need good cooperation and strong support from patients and their families. Doctors need to consider prospective strategy design before treatment, efficient and strong early transformative systemic treatment, and toxicity management. In local treatment, different surgeries need seamless connection and good cooperation. During operation, anesthesia and active cooperation in operating room are needed. Every detail determines the success or failure of treatment. under the leadership of chief experts Professor Wan Desen, president Xu Ruihua and director Pan Zhizhong, the colorectal cancer MDT team of cancer prevention and treatment center of Sun Yat sen University has become more and more mature. All departments abandon the conflict of interest, insist on putting patients' interests first and actively practice MDT practice. with the help of Professor Yuan Yunfei and important members of his team, Professor Zheng Yun, Professor Li binkui and Dr. He Wei, the Department of hepatobiliary surgery is the rock in our heart. Thank them again for the sake of patients, this profession and CRC MDT, as a big family, has made great efforts. I am always on call. I am very sorry for the long work every time. Mr. Zhang Rongxin, the director of the hospital, had to stay in the same operation room after leaving the hospital. I believe that the improvement of patients is the most gratifying good news for us, which makes us feel that all the efforts are worth it. Br / > as far as the patient's fate is concerned, it's up to the doctor and the patient to make arrangements. Biology is King！ Let's "know the destiny and try our best"! Professor Chen Gong, chief physician, doctoral supervisor, Department of colorectal cancer, Affiliated Cancer Hospital, Sun Yat sen University Deputy director; Deputy Secretary General and executive director of China Society of Clinical Oncology; Deputy Secretary General of the Asian Association of Clinical Oncology (FACO); chairman of colorectal cancer special committee of Guangdong anti cancer association; member of the Standing Committee of CSCO Colorectal Cancer Committee; member of CSCO national gastrointestinal stromal tumor Expert Committee; gastrointestinal and pancreatic neuroendocrine tumor Member of expert committee, standing member of colorectal surgery branch of Chinese Medical Doctor Association, vice chairman of tumor MDT special committee of China Association of research hospitals, vice chairman of metastatic liver cancer committee of international hepatobiliary pancreatic Association, and vice chairman of liver metastasis branch of colorectal cancer special committee of Chinese Medical Doctor Association| Prof. Chen Gong case sharing: surgical exploration is the most reliable method for diagnosis and evaluation of localized peritoneal carcinoma! 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