急腹症风险下转移灶不可切除结直肠癌原发灶的处理方式选择

doi:10.3760/cma.j.cn371439-20210714-00137

摘要/Abstract

摘要：

对于转移性结直肠癌患者,当转移灶不可切除时原发灶是否需要手术治疗尚存争议,原发灶姑息手术切除对改善预后、延长生存的作用尚不能肯定,但并发急腹症的风险引发对原发灶早期姑息手术切除的讨论,评价和预测结直肠癌并发急腹症的风险有助于转移灶不可切除转移性结直肠癌原发灶处理方式的选择。

关键词: 结直肠肿瘤, 急腹症, 肠梗阻, 消化系统外科手术, 肿瘤治疗方案

Abstract:

For patients with metastatic colorectal cancer, it is still controversial whether the primary tumor needs surgery when the metastasis is unresectable. The effect of palliative surgical resection of the primary lesion on improving the prognosis and prolonging survival is still uncertain while the risks of acute abdomen trigger the discussion of early palliative surgical resection of the primary tumor. Evaluating and predicting the risk of acute abdomen complicated by colorectal cancer will help to choose the treatment of the primary lesion of unresectable metastatic colorectal cancer.

Key words: Colorectal neoplasms, Acute abdomen, Intestinal obstruction, Digestive system surgical procedures, Antineoplastic protocols

施玥, 李晟, 冯继锋. 急腹症风险下转移灶不可切除结直肠癌原发灶的处理方式选择[J]. 国际肿瘤学杂志, 2021, 48(11): 693-697.

Shi Yue, Li Shen, Feng Jifeng. Treatment options for colorectal cancer primary lesions with unresectable metastases at risk of acute abdomen[J]. Journal of International Oncology, 2021, 48(11): 693-697.

参考文献 51

[1]	Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(3):145-164. DOI: 10.3322/caac.21601. doi: 10.3322/caac.v70.3
[2]	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132. DOI: 10.3322/caac.21338. doi: 10.3322/caac.21338
[3]	Hu Z, Ding J, Ma Z, et al. Quantitative evidence for early metastatic seeding in colorectal cancer[J]. Nat Genet, 2019, 51(7):1113-1122. DOI: 10.1038/s41588-019-0423-x. doi: 10.1038/s41588-019-0423-x
[4]	Hellman S, Weichselbaum R. Oligometastases[J]. J Clin Oncol, 1995, 13(1):8-10. DOI: 10.1200/JCO.1995.13.1.8. pmid: 7799047
[5]	Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer[J]. Ann Oncol, 2016, 27(8):1386-1422. DOI: 10.1093/annonc/mdw235. doi: 10.1093/annonc/mdw235 pmid: 27380959
[6]	Govaert KM, Jongen JMJ, Kranenburg O, et al. Surgery-induced tumor growth in (metastatic) colorectal cancer[J]. Surg Oncol, 2017, 26(4):535-543. DOI: 10.1016/j.suronc.2017.10.004. doi: S0960-7404(17)30328-6 pmid: 29113675
[7]	Sultana A, Meng R, Piantadosi C, et al. Liver resection for colorectal cancer metastases: a comparison of outcomes over time in South Australia[J]. HPB (Oxford), 2018, 20(4):340-346. DOI: 10.1016/j.hpb.2017.10.005. doi: 10.1016/j.hpb.2017.10.005
[8]	Thompson R, Cheung P, Chu W, et al. Outcomes of extra-cranial stereotactic body radiotherapy for metastatic colorectal cancer: dose and site of metastases matter[J]. Radiother Oncol, 2020, 142:236-245. DOI: 10.1016/j.radonc.2019.08.018. doi: S0167-8140(19)33064-6 pmid: 31543287
[9]	Löffler MW, Nussbaum B, Jäger G, et al. A non-interventional clinical trial assessing immune responses after radiofrequency ablation of liver metastases from colorectal cancer[J]. Front Immunol, 2019, 10:2526. DOI: 10.3389/fimmu.2019.02526. doi: 10.3389/fimmu.2019.02526 pmid: 31803175
[10]	Yoshino T, Arnold D, Taniguchi H, et al. Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS[J]. Ann Oncol, 2018, 29(1):44-70. DOI: 10.1093/annonc/mdx738. doi: 10.1093/annonc/mdx738 pmid: 29155929
[11]	Ahmed S, Leis A, Chandra-Kanthan S, et al. Surgical management of the primary tumor in stage Ⅳ colorectal cancer: a confirmatory retrospective cohort study[J]. J Cancer, 2016, 7(7):837-845. DOI: 10.7150/jca.14717. doi: 10.7150/jca.14717
[12]	Karoui M, Roudot-Thoraval F, Mesli F, et al. Primary colectomy in patients with stage Ⅳ colon cancer and unresectable distant metastases improves overall survival: results of a multicentric study[J]. Dis Colon Rectum, 2011, 54(8):930-938. DOI: 10.1097/DCR.0b013e31821cced0. doi: 10.1097/DCR.0b013e31821cced0 pmid: 21730780
[13]	Park EJ, Baek JH, Choi GS, et al. The role of primary tumor resection in colorectal cancer patients with asymptomatic, synchronous, unresectable metastasis: a multicenter randomized controlled trial[J]. Cancers (Basel), 2020, 12(8):2306. DOI: 10.3390/cancers12082306. doi: 10.3390/cancers12082306
[14]	Simillis C, Kalakouti E, Afxentiou T, et al. Primary tumor resection in patients with incurable localized or metastatic colorectal cancer: a systematic review and meta-analysis[J]. World J Surg, 2019, 43(7):1829-1840. DOI: 10.1007/s00268-019-04984-2. doi: 10.1007/s00268-019-04984-2
[15]	Nitsche U, Stöß C, Stecher L, et al. Meta-analysis of outcomes following resection of the primary tumour in patients presenting with metastatic colorectal cancer[J]. Br J Surg, 2018, 105(7):784-796. DOI: 10.1002/bjs.10682. doi: 10.1002/bjs.10682 pmid: 29088493
[16]	Hu CY, Bailey CE, You YN, et al. Time trend analysis of primary tumor resection for stage Ⅳ colorectal cancer: less surgery, improved survival[J]. JAMA Surg, 2015, 150(3):245-251. DOI: 10.1001/jamasurg.2014.2253. doi: 10.1001/jamasurg.2014.2253
[17]	Shapiro M, Rashid NU, Whang EE, et al. Trends and predictors of resection of the primary tumor for patients with stage Ⅳ colorectal cancer[J]. J Surg Oncol, 2015, 111(7):911-916. DOI: 10.1002/jso.23906. doi: 10.1002/jso.23906 pmid: 25919984
[18]	Scheer MG, Sloots CE, van der Wilt GJ, et al. Management of patients with asymptomatic colorectal cancer and synchronous irresectable metastases[J]. Ann Oncol, 2008, 19(11):1829-1835. DOI: 10.1093/oxfordjournals.annonc.a058345. doi: 10.1093/annonc/mdn398 pmid: 18662955
[19]	Fiori E, Lamazza A, Schillaci A, et al. Palliative management for patients with subacute obstruction and stage Ⅳ unresectable rectosigmoid cancer: colostomy versus endoscopic stenting: final results of a prospective randomized trial[J]. Am J Surg, 2012, 204(3):321-326. DOI: 10.1016/j.amjsurg.2011.11.013. doi: 10.1016/j.amjsurg.2011.11.013
[20]	Pothuri B, Vaidya A, Aghajanian C, et al. Palliative surgery for bowel obstruction in recurrent ovarian cancer: an updated series[J]. Gynecol Oncol, 2003, 89(2):306-313. DOI: 10.1016/s0090-8258(03)00073-8. doi: 10.1016/S0090-8258(03)00073-8
[21]	Parveen Z, Qureshi AN, Akbar M, et al. Palliative surgery for intestinal obstruction due to recurrent ovarian cancer[J]. J Ayub Med Coll Abbottabad, 2009, 21(1):135-136.
[22]	Bankole AO, Osinowo AO, Adesanya AA. Predictive factors of management outcome in adult patients with mechanical intestinal obstruction[J]. Niger Postgrad Med J, 2017, 24(4):217-223. DOI: 10.4103/npmj.npmj_143_17. doi: 10.4103/npmj.npmj_143_17
[23]	Spears H, Petrelli NJ, Herrera L, et al. Treatment of bowel obstruction after operation for colorectal carcinoma[J]. Am J Surg, 1988, 155(3):383-386. DOI: 10.1016/s0002-9610(88)80095-3. pmid: 3344898
[24]	Chang HK, Min BS, Ko YT, et al. Obstructive colitis proximal to obstructive colorectal carcinoma[J]. Asian J Surg, 2009, 32(1):26-32. DOI: 10.1016/S1015-9584(09)60005-1. doi: 10.1016/S1015-9584(09)60005-1
[25]	Winner M, Mooney SJ, Hershman DL, et al. Management and outcomes of bowel obstruction in patients with stage Ⅳ colon cancer: a population-based cohort study[J]. Dis Colon Rectum, 2013, 56(7):834-843. DOI: 10.1097/DCR.0b013e31-8294ed6b. doi: 10.1097/DCR.0b013e318294ed6b pmid: 23739189
[26]	Kolomainen DF, Daponte A, Barton DP, et al. Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC)[J]. Gynecol Oncol, 2012, 125(1):31-36. DOI: 10.1016/j.ygyno.2011.11.007. doi: 10.1016/j.ygyno.2011.11.007 pmid: 22082991
[27]	Jackson P, Vigiola Cruz M. Intestinal obstruction: evaluation and management[J]. Am Fam Physician, 2018, 98(6):362-367.
[28]	Jaffe T, Thompson WM. Large-bowel obstruction in the adult: classic radiographic and CT findings, etiology, and mimics[J]. Radiology, 2015, 275(3):651-663. DOI: 10.1148/radiol.2015140916. doi: 10.1148/radiol.2015140916
[29]	Cousins SE, Tempest E, Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer[J]. Cochrane Database Syst Rev, 2016, 2016(1): CD002764. DOI: 10.1002/14651858.CD002764.pub2.
[30]	Watson J, Mannix K, Matthewson K. Percutaneous endoscopic gastroenterostomy and jejunal extension for gastric stasis in pancreatic carcinoma[J]. Palliat Med, 1997, 11(5):407-410. DOI: 10.1177/026921639701100512. pmid: 9472599
[31]	Wangensteen OH. Historical aspects of the management of acute intestinal obstruction[J]. Surgery, 1969, 65(2):363-383.
[32]	Laval G, Marcelin-Benazech B, Guirimand F, et al. Recom-mendations for bowel obstruction with peritoneal carcinomatosis[J]. J Pain Symptom Manage, 2014, 48(1):75-91. DOI: 10.1016/j.jpainsymman.2013.08.022. doi: 10.1016/j.jpainsymman.2013.08.022
[33]	Chen TM, Huang YT, Wang GC. Outcome of colon cancer initially presenting as colon perforation and obstruction[J]. World J Surg Oncol, 2017, 15(1):164. DOI: 10.1186/s12957-017-1228-y. doi: 10.1186/s12957-017-1228-y
[34]	McQuade RM, Stojanovska V, Stavely R, et al. Oxaliplatin-induced enteric neuronal loss and intestinal dysfunction is prevented by co-treatment with BGP-15[J]. Br J Pharmacol, 2018, 175(4):656-677. DOI: 10.1111/bph.14114. doi: 10.1111/bph.v175.4
[35]	McQuade RM, Carbone SE, Stojanovska V, et al. Role of oxidative stress in oxaliplatin-induced enteric neuropathy and colonic dysmotility in mice[J]. Br J Pharmacol, 2016, 173(24):3502-3521. DOI: 10.1111/bph.13646. doi: 10.1111/bph.v173.24
[36]	Winner M, Mooney SJ, Hershman DL, et al. Incidence and predictors of bowel obstruction in elderly patients with stage Ⅳ colon cancer: a population-based cohort study[J]. JAMA Surg, 2013, 148(8):715-722. DOI: 10.1001/jamasurg.2013.1. doi: 10.1001/jamasurg.2013.1 pmid: 23740130
[37]	Anwar S, Peter MB, Dent J, et al. Palliative excisional surgery for primary colorectal cancer in patients with incurable metastatic disease. Is there a survival benefit? A systematic review[J]. Colorectal Dis, 2012, 14(8):920-930. DOI: 10.1111/j.1463-1318.2011.02817.x. doi: 10.1111/j.1463-1318.2011.02817.x pmid: 21899714
[38]	Stillwell AP, Ho YH, Veitch C. Systematic review of prognostic factors related to overall survival in patients with stage Ⅳ colorectal cancer and unresectable metastases[J]. World J Surg, 2011, 35(3):684-692. DOI: 10.1007/s00268-010-0891-8. doi: 10.1007/s00268-010-0891-8 pmid: 21181473
[39]	Kanemitsu Y, Shitara K, Mizusawa J, et al. Primary tumor resection plus chemotherapy versus chemotherapy alone for colorectal cancer patients with asymptomatic, synchronous unresectable metastases (JCOG1007; iPACS): a randomized clinical trial[J]. J Clin Oncol, 2021, 39(10):1098-1107. DOI: 10.1200/JCO.20.02447. doi: 10.1200/JCO.20.02447 pmid: 33560877
[40]	Søreide K. Resection of asymptomatic primary tumour in unresectable stage Ⅳ colorectal cancer: time to move on from propensity matched scores to randomized controlled trials[J]. Int J Cancer, 2016, 139(9):1927-1929. DOI: 10.1002/ijc.30244. doi: 10.1002/ijc.30244 pmid: 27400774
[41]	Gelsomino F, Spallanzani A, Orsi G, et al. To resect or not to resect: the hamletic dilemma of primary tumor resection in patients with asymptomatic stage Ⅳ colorectal cancer[J]. Crit Rev Oncol Hematol, 2018, 132:154-160. DOI: 10.1016/j.critrevonc.2018.10.001. doi: S1040-8428(18)30201-4 pmid: 30447921
[42]	Touchefeu Y, Montassier E, Nieman K, et al. Systematic review: the role of the gut microbiota in chemotherapy- or radiation-induced gastrointestinal mucositis-current evidence and potential clinical applications[J]. Aliment Pharmacol Ther, 2014, 40(5):409-421. DOI: 10.1111/apt.12878.
[43]	Ferreira M, Andreyev HJ. Editorial: gut microbiota and chemotherapy- or radiation-induced gastrointestinal mucositis[J]. Aliment Pharmacol Ther, 2014, 40(6):733-734. DOI: 10.1111/apt.12905. doi: 10.1111/apt.2014.40.issue-6
[44]	Zeilstra J, Joosten SP, van Andel H, et al. Stem cell CD44v isoforms promote intestinal cancer formation in Apc(min) mice downstream of Wnt signaling[J]. Oncogene, 2014, 33(5):665-670. DOI: 10.1038/onc.2012.611. doi: 10.1038/onc.2012.611 pmid: 23318432
[45]	Gregorieff A, Liu Y, Inanlou MR, et al. Yap-dependent reprogramming of Lgr5(+) stem cells drives intestinal regeneration and cancer[J]. Nature, 2015, 526(7575):715-718. DOI: 10.1038/nature15382. doi: 10.1038/nature15382
[46]	Tauriello DVF, Palomo-Ponce S, Stork D, et al. TGFβ drives immune evasion in genetically reconstituted colon cancer metastasis[J]. Nature, 2018, 554(7693):538-543. DOI: 10.1038/nature25492. doi: 10.1038/nature25492
[47]	Pietrantonio F, Aprile G, Rimassa L, et al. A new nomogram for estimating survival in patients with brain metastases secondary to colorectal cancer[J]. Radiother Oncol, 2015, 117(2):315-321. DOI: 10.1016/j.radonc.2015.08.023. doi: 10.1016/j.radonc.2015.08.023 pmid: 26347495
[48]	Lv X, Yu H, Gao P, et al. A nomogram for predicting bowel obstruction in preoperative colorectal cancer patients with clinical characteristics[J]. World J Surg Oncol, 2019, 17(1):21. DOI: 10.1186/s12957-019-1562-3. doi: 10.1186/s12957-019-1562-3
[49]	Kijima S, Sasaki T, Nagata K, et al. Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT[J]. World J Gastroenterol, 2014, 20(45):16964-16975. DOI: 10.3748/wjg.v20.i45.16964. doi: 10.3748/wjg.v20.i45.16964
[50]	Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation[J]. World J Emerg Surg, 2018, 13:36. DOI: 10.1186/s13017-018-0192-3.
[51]	Lee NK, Kim S, Hong SB, et al. CT diagnosis of non-traumatic gastrointestinal perforation: an emphasis on the causes[J]. Jpn J Radiol, 2020, 38(2):101-111. DOI: 10.1007/s11604-019-00910-7. doi: 10.1007/s11604-019-00910-7