"Intestinal" short words. Professor Chen Gong Case Sharing: New Concept for Simultaneous Liver Metastasis for Colorectal Cancer: Liver First

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 has invited Professor Chen Gong from the cancer prevention and treatment center of Sun Yat sen University to create a special column called "short talk of bowel talk". From now on, it will be updated one after another to convey the latest research progress, the most cutting-edge diagnosis and treatment ideas, and the most practical clinical experience to each reader! Case history: a 49 year old female patient with liver metastasis from sigmoid colon cancer was diagnosed in June 2019, CEA & gt; 1000g / ml; colonoscopy showed hyperplasia of mucosal tumor at 22cm away from anus, and failed to pass through. Biopsy pathology in our hospital indicated that: (sigmoid colon biopsy) was moderately differentiated adenocarcinoma.CT: sigmoid colon cancer with abdominal and retroperitoneal lymph node metastasis, multiple liver metastasis. There were multiple angiomyolipomas in the right kidney.metastatic tumor of right kidney is to be excluded.July 4, 2019 PET-CT showed that the metabolism of sigmoid mass was active, considering malignant lesions, invasion of serosa and surrounding adipose tissue, the metabolism of lymph nodes around the lesion was slightly active, the metabolism of multiple low-density shadows in the liver was active, the metabolism of multiple nodule shadows and patch shadows in pelvic peritoneum was slightly active, and metastasis was considered; the metabolism of multiple lymph nodes in inferior vena cava, abdominal trunk, abdominal aorta and bilateral iliac vessels was slightly active Jump, move, wait.gene detection results: KRAS, NRAS and BRAF were wild type, tps3 missense mutation, low mutation load and stable microsatellite. Br / > in ivia stage, the diagnosis of sigmoid adenocarcinoma was considered.treatment: the patients were enrolled in the trice study, and were treated with FOLFOX + cetuximab for 8 courses from July 13 to October 15, 2019.ten courses of chemotherapy have been carried out, the last chemotherapy was on November 25, 2019, and CEA decreased from baseline 2549 to current 8.42.plain and enhanced MR scan of upper abdomen on December 3, 2019 (primax): multiple intrahepatic metastases, slightly smaller than the previous film.there were multiple cysts in the liver.abnormal signal foci in both kidneys may be considered as cysts, and some of them are complex cysts, which have no obvious change compared with before. There was no obvious change in splenic cyst.there were no significant changes in several lymph nodes adjacent to the abdominal aorta.the next treatment plan is to be consulted when returning to the hospital.physical examination: ln -, heart and lung -, abdominal tenderness, liver and spleen -, abdominal mass -, anal index 8cm, no abnormality; rash degree 2.treatment plan: it is suggested that hepatobiliary surgery should be consulted to determine whether it can be resected. If it can be resected, intestinal liver surgery or liver surgery should be performed at the same time, and then intestinal resection should be performed in stages.Prof. Chen Gong: case review and comments: liver first is a new mode of surgical resection for simultaneous liver metastases from colorectal cancer, but the overall application is still less than the traditional mode of simultaneous resection of liver and intestine.Liver First is generally used when liver metastases are not easy to be resectable after early effective systemic treatment, but patients are not suitable for simultaneous resection of intestinal and liver in terms of surgical safety. If the traditional mode is followed by intestine and liver, then when the second stage hepatectomy is completed, due to the suspension of systemic treatment, liver metastases may progress after surgery and lose the resection machine Yes, on the contrary, the resectability of primary intestinal lesions is much higher than that of liver metastases. Even if local progression occurs during the waiting period, this is the best indication for life first. however, the most worrying thing about this mode is that two operations are performed, and the long-term suspension of systemic treatment leads to distant disease progression. for example, in this case, the largest liver metastasis is close to the main hepatic vessels and needs to be transformed technically. After systemic treatment with chemotherapy FOLFOX + irbutol, it is very effective and the transformation is successful. However, after comprehensive evaluation of MDT, it is considered that simultaneous resection of the liver and intestines is difficult to tolerate, so it is decided to live first. liver resection (3 resection and 3 ablation) was performed on January 4, 2020, and intestinal resection was performed on February 21, 2020. Chest CT and liver MRI were reviewed before intestinal resection, and no progress was found. intraoperative exploration revealed right ovarian metastasis (pelvic CT before hepatectomy is OK). fortunately, there was no implant metastasis in abdominal and pelvic cavity, so R0 resection was still performed. however, the prognosis of this kind of patients who progressed after two operations was not very good. interestingly, the patient was found to have a congenital right double ureter. 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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