Expressing the Surgery First Position on Treatment of Synchronous Colorectal Metastases in the Asymptomatic Patient

摘要: The patient is asymptomatic with synchronous hepatic metastases from a colorectal primary tumor. options for treatment would be to resect the tumor and treat liver or give chemotherapy first then see if resection feasible. ultimate goal of every cancer surgeon cure patient. For vast majority patients metastatic disease, this impossible. In those situations, surgery must used as palliative tool; thus, extirpative generally not needed in patient, especially advent new agents that have such good response rates cancer. However, only, there remains chance cure, should always pursued. New data about artery infusions face unresectable show extremely high make converting disease into resectable lesions possible reality. Thus, who capable undergoing has best placement infusion pump pump. Treatment systemic before help situation may allow potentially curable become too large resection. Synchronous tumors occur approximately 20% question operability does hinge on whether are synchronous. Because can also 5-year survivals >25%, they excluded important factors assessing been assessed by two groups retrospective studies. Both these were addressing confined liver, thus portal lymph nodes involved tumor, carcinomatosis, lung other organ considered candidates One systems was developed Dr. Yuman Fong at Memorial Sloan-Kettering Cancer Center included five clinical criteria. They (1) nodal status (2) disease-free interval time operation discovery (£12 >12 months), (3) more than one (4) preoperative carcinoembryonic antigen level >200 ng/mL, (5) largest >5 cm. Each negative criterion assigned point, calculated. score 0, survival 60%, compared 14% Received July 27, 2005; accepted October 24, published online January 16, 2006. Address correspondence reprint requests to: M. Margaret Kemeny, MD, FACS; E-mail: kemenym@nychhc.org