RESUMEN
PURPOSE: The simultaneous management of primary colorectal cancer and synchronous liver metastases has been reported extensively in open surgery. Data regarding feasibility, safety, and outcomes of the laparoscopic procedure is emerging from the experience of a few surgical centers. This paper aims at discussing the technique and results of a one-step laparoscopic approach for colorectal cancer and liver metastases resection on a series of 35 patients. METHODS: Between January 2008 and December 2013, 18 males and 17 females (median age 71 years) underwent colorectal and hepatic laparoscopic resection for colorectal metastatic cancer. RESULTS: Thirty-five colorectal resections and 66 liver resections were performed; no conversion to open surgery has been indicated. Median blood loss was 200 ml, median operative time 240 min, and median hospital stay was 8 days (range 4-30). According to Clavien-Dindo classification, two class II complications, two class IIIb complications, and one class IV complication were recorded. Two high-risk patients died within 30 days from surgery. CONCLUSIONS: This series confirms the feasibility of synchronous laparoscopic colorectal and hepatic resections. To ensure the best outcomes, a careful selection of patients is needed. However, most patients can benefit from this surgical approach.
Asunto(s)
Colectomía/métodos , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Hepatectomía/métodos , Laparoscopía/métodos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica , Contraindicaciones , Femenino , Hemostasis Quirúrgica , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: The purpose of the study was to evaluate activity and toxicity of the combination of topotecan and ifosfamide as salvage treatment in patients with advanced ovarian cancer refractory to or relapsing after platinum compound-based chemotherapy. METHODS: Thirty-nine patients entered the trial. Inclusion criteria were: previous platinum compound-based chemotherapy with or without paclitaxel, age =75 years, ECOG PS =2, and measurable or evaluable lesions. Treatment consisted of topotecan 1.3 mg/sqm d. 1-3 in combination with ifosfamide 1500 mg/sqm d. 1 and 2 (plus uroprotector MESNA), q. 21 days. RESULTS: All patients had received previous platinum compound-based chemotherapy (carboplatin + paclitaxel in 72% of patients); 15 patients had received a further second-line therapy. Overall, 179 cycles were administered; median number courses/patient was 5 (range: 1-8). Eighteen patients received at least six courses of therapy. All patients were evaluable for toxicity and 38 patients for response. Main toxicities consisted of gr3-4 neutropenia in 25%, gr3 anaemia in 18%, neutropenic fever in four patients; 7 patients required blood transfusion and 26 patients were treated with G-CSF. Dose reduction of both drugs was performed in five patients, and seven patients required 1-week delay for recovery of toxicity. Objective response was observed in 16/39 patients (41%): complete response in six patients and partial response in 10 patients; in further three patients, >/=50% reduction of baseline CA-125 was recorded. Significant higher response rate was observed in platinum-sensitive population (11/15 patients) compared to resistant disease (8/24 patients). CONCLUSIONS: Chemotherapy with topotecan and ifosfamide (IT) in pretreated advanced ovarian cancer patients is feasible with moderate toxicity. The potential of the regimen for synergistic drug interactions deserves further evaluations.