结直肠癌肝转移新辅助化疗的共识与争议PPT.pptVIP

Clinical outcome related to liver damage Steatosis associated with higher infection rate (Kooby et al, 2003) Steatohepatitis associated with higher mortality rate due to liver failure after surgery (Vauthey et al. 2006) Vascular injury associated with higher rate of operative bleeding and transfusion requirement (Vauthey et al. 2006. Aloia et al. 2006 ) Peroperative chemotherapy:potential problems EORTC 40983:impact of pre-operative chemotherapy on surgery B O S (Biologics,Oxaliplatin,Surgery)EORTC 40051 Resectable CRC liver metastases: Unanswered Questions Is peri-operative chemotherapy superior to post-operative chemotherapy? How much preoperative chemotherapy? How do you assess nature and extent of chemotherapy-induced liver injury? Do targeted agents modulate chemotherapy-induced liver injury? Neoadj for unresectable liver metastases of CRC Chemotherapy for unresectable Is there a benefit to add surgery to chemotherapy? To which patients? With what regimens? After how much duration of treatment? Take-home message Chemotherapy for unresectable Is there a benefit to add surgery to chemotherapy? To which patients? With what regimens? After how much duration of treatment? Take-home message Downstaging UnresectableColorectal Metastases Response to neoadjuvant chemothrapy Survival after liver Resection of Non Resectable Colorectal Matastases after Systemic Chemotherapy Survival after liver Resection of Colorectal Matastases Survival After Chemotherapy For CRLM Effective Preoperative Therapy+Hepatic Resection:Long-term Results in “unresectable” Patients Chemotherapy for unresectable Is there a benefit to add surgery to chemotherapy? To which patients? With what regimens? After how much duration of treatment? Take-home message A Model to predict Survival after Liver resection of Non Resectable Colorectal Metastases Comparison of patient characteristics between cured and non-cured patients Adam R ,ASCO 2008 abstr 4023