Abstract: Objective:To investigate the safety and clinical effect of Ⅰstage resection of colon cancer and synchronous liver metastasis after conversion therapy.
Methods:The retrospective descriptive study was adopted. The clinical data of 1 patient with sigmoid cancer with synchronous multiple liver metastases who was admitted to the Zhongshan Hospital of Fudan University in April 2013 were collected. The patient was diagnosed as sigmoid cancer with multiple lymph nodes surrounding colon and 5 metastatic lesions found in liver by preoperative imaging examination, and the maximum diameters of 2 metastatic lesions were 4.5 cm and 3.6 cm. The pathological results of colonoscopy indicated adenocarcinoma. After discussion of the multidisciplinary team, liver metastatic lesions were significantly reduced through mFOLFOX6 chemotherapy combined with bevacizumab treatment, and then patient underwent Ⅰstage resection of colon cancer with synchronous liver metastasis by the surgical procedures of partial hepatectomy+3D laparoscopyassisted radical resection of sigmoid cancer. The patient received convention treatment of antibiotic, nutrition support therapy and mFOLFOX6 adjuvant chemotherapy. The changes of lesions in liver and tumor markers were observed by tumor marker test, abdominal-/pelvic CT and MRI in the upper abdomen after conversion therapy. The operation time, volume of intraoptrative blood loss, number of lymph nodes dissected and vital sign were observed in the operation. The liver function, time for outoffbed activity, time to anal exsufflation, time of drainage tube removal, duration of hospital stay, complications, results of pathological examination and recurrence and metastasis of tumor were observed after operation. After discharge from hospital, the patient underwent monthly tumor marker test, B ultrasound and chest Xray examination till January 2014 and abdominal/pelvic CT, magnetic resonance imaging (MRI) in the upper abdomen and colonoscopy every 6 months. The followup of outpatient examination and telephone interview was performed to detect the recurrence and metastasis of tumor up to September 2015.
Results:After preoperative 4cycle chemotherapy, the diameters of 2 metastatic lesions in liver reduced to 3.2 cm and 2.0 cm, the levels of carcinoembryonic antigen(CEA) and CA19-9 (tumor marker) were reduced to 95.9 μg/L and 252.4 kU/L. The patient underwent successful Ⅰstage resection of colon cancer and synohronous liver metastasis. The operation time, volume of intraoperative blood loss, numbers of lymph nodes dissected and cancerous nodes were 208 minutes, 250mL, 14 and 1, respectively.The patient had no blood transfusion and metastasis, with the stable vital signs and good postoperative recovery. The levels of alanine transaminase (ALT) and aspartate transaminase (AST) were 1 147 U/L and 2 631 U/L at postoperative day 1, 101 U/L and 37 U/L at postoperative day 7, respectively. The outoffbed activity, anal exsufflation, drainage tube removal and discharge from hospital were occurred at postoperative day 2, 3, 7 and 9, respectively. No anastomotic fistula, bleeding and infection were occurred after operation. The patient was diagnosed as with ulcerated sigmoid adenocarcinoma in T3N1cM1 stage (combining with liver metastasis). The patient received adjuvant therapy of mFOLFOX6 and oral capecitabine at postoperative day 40, and was followed up for 30 months with a good quality of life and without metastasis and recurrence.
Conclusion:Ⅰstage resection of colon cancer with synohronous liver metastasis can be used for initial unresectable colon cancer with liver metastasis after conversion therapy, and it is safe and feasible, with a good therapeutic effect.