Kolorektal karsinomlarda karaciğer metastazlarının segmental dağılımının bilgisayarlı tomografi ile değerlendirilmesi
Öz
Giriş: Bu çalışmada kolorektal karsinomlar ile metastatik karaciğer lezyonlarının topografik dağılımı arasındaki ilişki araştırılmıştır. Gereç ve Yöntemler: Kolorektal kanseri ve metastatik karaciğer lezyonları olan hastalar bu çalışmanın hedef popülasyonunu oluşturdu. Demografik veriler, primer tümör lokalizasyonu, ve metastatik karaciğer lezyonlarının segmental dağılımına ilişkin veriler retrospektif olarak tarandı. Hasta dosyaları, endoskopi ve bilgisayarlı tomografi raporları gözden geçirildi. Ek olarak hastaların Couinaud klasifikasyonuna göre belirlenmiş olan metastatik karaciğer lezyonlarının segmental dağılım bilgileri tarandı. Bulgular: Doksan altı hastanın karaciğer metastazı yapmış kolorektal kanseri tanısı almış olduğu öğrenildi. Toplamda 251 metastatik karaciğer lezyonu saptandı. Bunların 169 (%67.3) tanesi sağ lobda, 80 (%31.9) tanesi ise sol lobda yer almaktaydı (p<0.0001). Couinaud klasifikasyonuna göre yapılmış olan değerlendirmede en sık etkilenmiş olanın segment VIII (%23.1), en nadir etkilenmiş olanın ise segment 1 (kaudat lob) öldüğü anlaşıldı. En sık tutulan karaciğer segmentleri sırasıyla segment VIII, V, VII, VI, III, II, IV, ve segment I`di. Primer tümörü sağ ve sol kolonda olan hastalar kıyaslandığında metastatik lezyonların segmental dağılımı açısından belirgin fark saptanmadı (p>0.05). Sonuç: Kolorektal kanserlerin karaciğer metastazları kolorektal tümörün lokalizasyonundan bağımsız olarak daha sağ lobda sol lobdan daha sıktır. Segment 8 en sık tutulan segmenttir.
Anahtar Kelimeler
kolorektal karsinom karaciğer metastazı segmental dağılım Couinaud klasifikasyonu
Kaynakça
- 1. Ansa BE, Coughlin SS, Alema-Mensah E, Smith SA. Evaluation of Colorectal Cancer Incidence Trends in the United States (2000-2014). J Clin Med 2018;7:22.
- 2. Strohmeyer T, Schultz W. The distribution of metastases of different primary tumors in the liver. Liver 1986;6:184–7.
- 3. Wigmore SJ, Madhavan K, Redhead DN, Currie EJ, Garden OJ. Distribution of colorectal liver metastases in patients referred for hepatic resection. Cancer 2000;89:285–7.
- 4. Desai AG, Park CH, Schilling JF. "Streaming" in portal vein. Its effect on the spread of metastases to the liver. Clin Nucl Med 1985;10:556-9.
- 5. Dionne L. The pattern of blood-borne metastasis from carcinoma of rectum. Cancer 1965; 18:775-81.
- 6. Schulz W, Hagen C, Hort W. The distribution of liver metastases from colonic cancer. A quantitative postmortem study. Virchows Arch A Pathol Anat Histopathol 1985;406:279–84.
- 7. Sica GT, Ji H, Ros PR. CT and MR imaging of hepatic metastases. AJR Am J Roentgenol 2000;174:691–8.
- 8. Engstrand J, Nilsson H, Strömberg C, Jonas E, Freedman J. Colorectal cancer liver metastases - a population-based study on incidence, management and survival. BMC Cancer 2018;18:78.
- 9. Temple DF, Parthasarathy KL, Bakshi SP, Mittelman AE. A comparison of isotopic and computerized tomographic scanning in the diagnosis of metastasis to the liver in patients with adenocarcinoma of the colon and rectum. Surg Gynecol Obstet 1983;156:205-8.
- 10. Sugarbaker PH. Surgical decision making for large bowel cancer metastatic to the liver. Radiology 1990;174:621–6.
- 11. Couinaud C. Le foie; études anatomiques et chirurgicales. Paris: Masson; 1957.
- 12. Mohamed E, Adiamah A, Dunn WK, Higashi Y, Cameron IC, Gomez D. Outcome of indeterminate liver lesions on computed tomography in patients with colorectal cancer. Ann R Coll Surg Engl 2018;100:382–7.
- 13. Tartter PI, Slater G, Gelernt I, Aufses AH. Screening for liver metastases from colorectal cancer with carcinoembryonic antigen and alkaline phosphatase. Ann Surg 1981;193:357–60.
- 14. Pinson CW, Kelly Wright J, Chapman WC, Louis Garrard C, Blair TK, Sawyers JL. Repeat hepatic surgery for colorectal cancer metastasis to the liver. Ann Surg 1996;223:765–76.
- 15. Bismuth H, Houssin D, Castaing D. Major and minor segmentectomies “réglées” in liver surgery. World J Surg 1982;6:10–24.
- 16. Sugarbaker PH, Nelson RC, Murray DR, Chezmar JL, Bernardino ME. A segmental approach to computerized tomographic portography for hepatic resection. Surg Gynecol Obstet 1990;171:189–95.
- 17. Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg 1982;6:3–9.
- 18. Dodd GD. An American’s guide to Couinaud’s numbering system. AJR Am J Roentgenol 1993;161:574–5.
- 19. Ackerman NB. Experimental studies on the role of the portal circulation in hepatic tumor vascularity. Cancer 1986;58:1653-7.
- 20. Rhu J, Heo JS, Choi SH, Choi DW, Kim JM, Joh JW, Kwon CHD. Streamline flow of the portal vein affects the lobar distribution of colorectal liver metastases and has a clinical impact on survival. Ann Surg Treat Res 2017;92:348–54.
- 21. Kadiyoran C, Cizmecioglu HA, Cure E, Yildirim MA, Yilmaz PD. Liver metastasis in colorectal cancer: evaluation of segmental distribution. Prz Gastroenterol 2019;14:188–92.
- 22. Holbrook RF, Rodriguez-Bigas MA, Ramakrishnan K, Blumenson L, Petrelli NJ. Patterns of colorectal liver metastases according to Couinaud’s segments. Dis Colon Rectum 1995;38:245–8.
- 23. Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 2006;244:254–9.
- 24. Sérégé H. Contribution à létude de la circulation du sang porte dans le foie et des localizations lobaires hepatiques. J méd Bordeaux 1901;31:271-312.
- 25. Moore GE, Bridenbaugh RB. Roentgen demonstration of the venous circulation in the liver; portal venography. Radiology 1951;57:685–90.
- 26. Ambrosetti MC, Zamboni GA, Mucelli RP. Distribution of liver metastases based on the site of primary pancreatic carcinoma. Eur Radiol [Internet]. 2016;26:306–10.
- 27. Shirai Y, Wakai T, Ohtani T, Sakai Y, Tsukada K, Hatakeyama K. Colorectal carcinoma metastases to the liver. Does primary tumor location affect its lobar distribution? Cancer 1996;77:2213-6.
- 28. Falconer CWA, Griffiths E. The anatomy of the blood-vessels in the region of the pancreas. Br J Surg 1950;37:334–44.
- 29. Aktan ZA, Govsa F, Hancl IH, Karadeniz Z, Ozgur T, Ege B. An anatomic study on the portal vein formation. Medical J Eng University 1995; 5: 5-8.
- 30. Nelson RC, Chezmar JL, Sugarbaker PH, Murray DR, Bernardino ME. Preoperative localization of focal liver lesions to specific liver segments: utility of CT during arterial portography. Radiology 1990;176:89–94.
Evaluation of segmental distribution of liver metastases in colorectal carcinomas by computed tomography
Öz
Objective: We aimed to investigate the relationship between the localization of colorectal carcinomas and the topographic distribution of metastatic liver lesions. Material and Methods: Patients diagnosed with colorectal cancer and metastatic liver lesions constituted the target population of this study. Demographic data, primary tumor localization, and data regarding liver metastases were retrieved and retrospectively reviewed. Patient files, including endoscopy and computerized tomography reports, were the primary data source. In addition, data concerning segmental localization of the metastatic liver lesions based on the Couinaud classification were collected. Results: Ninety-six patients were diagnosed with colorectal cancer with liver metastases during the study period. A total of 251 metastases were detected. The number of metastases was 169 (67.3%) in the right and 80 (31.9%) in the left lobe (p<0.0001). Evaluation regarding Couinaud classification elucidated that the most frequently affected segment was segment VIII (23.1%), while segment 1 (i.e., caudate lobe) was the least commonly affected segment. The liver segments with the highest number of metastatic lesions were VIII, V, VII, VI, III, II, IV, and I, respectively. There was no significant difference in the segmental distribution of metastases in patients with primary tumors in the right and left colon (p>0.05). Conclusion: Liver metastases of colorectal cancer are significantly more common in the right lobe than the left lobe, irrespective of the location of the colorectal tumor. Segment VIII of the right lobe is the main target of the metastases.
Anahtar Kelimeler
colorectal carcinoma liver metastasis segmental distribution Couinaud classification
Kaynakça
- 1. Ansa BE, Coughlin SS, Alema-Mensah E, Smith SA. Evaluation of Colorectal Cancer Incidence Trends in the United States (2000-2014). J Clin Med 2018;7:22.
- 2. Strohmeyer T, Schultz W. The distribution of metastases of different primary tumors in the liver. Liver 1986;6:184–7.
- 3. Wigmore SJ, Madhavan K, Redhead DN, Currie EJ, Garden OJ. Distribution of colorectal liver metastases in patients referred for hepatic resection. Cancer 2000;89:285–7.
- 4. Desai AG, Park CH, Schilling JF. "Streaming" in portal vein. Its effect on the spread of metastases to the liver. Clin Nucl Med 1985;10:556-9.
- 5. Dionne L. The pattern of blood-borne metastasis from carcinoma of rectum. Cancer 1965; 18:775-81.
- 6. Schulz W, Hagen C, Hort W. The distribution of liver metastases from colonic cancer. A quantitative postmortem study. Virchows Arch A Pathol Anat Histopathol 1985;406:279–84.
- 7. Sica GT, Ji H, Ros PR. CT and MR imaging of hepatic metastases. AJR Am J Roentgenol 2000;174:691–8.
- 8. Engstrand J, Nilsson H, Strömberg C, Jonas E, Freedman J. Colorectal cancer liver metastases - a population-based study on incidence, management and survival. BMC Cancer 2018;18:78.
- 9. Temple DF, Parthasarathy KL, Bakshi SP, Mittelman AE. A comparison of isotopic and computerized tomographic scanning in the diagnosis of metastasis to the liver in patients with adenocarcinoma of the colon and rectum. Surg Gynecol Obstet 1983;156:205-8.
- 10. Sugarbaker PH. Surgical decision making for large bowel cancer metastatic to the liver. Radiology 1990;174:621–6.
- 11. Couinaud C. Le foie; études anatomiques et chirurgicales. Paris: Masson; 1957.
- 12. Mohamed E, Adiamah A, Dunn WK, Higashi Y, Cameron IC, Gomez D. Outcome of indeterminate liver lesions on computed tomography in patients with colorectal cancer. Ann R Coll Surg Engl 2018;100:382–7.
- 13. Tartter PI, Slater G, Gelernt I, Aufses AH. Screening for liver metastases from colorectal cancer with carcinoembryonic antigen and alkaline phosphatase. Ann Surg 1981;193:357–60.
- 14. Pinson CW, Kelly Wright J, Chapman WC, Louis Garrard C, Blair TK, Sawyers JL. Repeat hepatic surgery for colorectal cancer metastasis to the liver. Ann Surg 1996;223:765–76.
- 15. Bismuth H, Houssin D, Castaing D. Major and minor segmentectomies “réglées” in liver surgery. World J Surg 1982;6:10–24.
- 16. Sugarbaker PH, Nelson RC, Murray DR, Chezmar JL, Bernardino ME. A segmental approach to computerized tomographic portography for hepatic resection. Surg Gynecol Obstet 1990;171:189–95.
- 17. Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg 1982;6:3–9.
- 18. Dodd GD. An American’s guide to Couinaud’s numbering system. AJR Am J Roentgenol 1993;161:574–5.
- 19. Ackerman NB. Experimental studies on the role of the portal circulation in hepatic tumor vascularity. Cancer 1986;58:1653-7.
- 20. Rhu J, Heo JS, Choi SH, Choi DW, Kim JM, Joh JW, Kwon CHD. Streamline flow of the portal vein affects the lobar distribution of colorectal liver metastases and has a clinical impact on survival. Ann Surg Treat Res 2017;92:348–54.
- 21. Kadiyoran C, Cizmecioglu HA, Cure E, Yildirim MA, Yilmaz PD. Liver metastasis in colorectal cancer: evaluation of segmental distribution. Prz Gastroenterol 2019;14:188–92.
- 22. Holbrook RF, Rodriguez-Bigas MA, Ramakrishnan K, Blumenson L, Petrelli NJ. Patterns of colorectal liver metastases according to Couinaud’s segments. Dis Colon Rectum 1995;38:245–8.
- 23. Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 2006;244:254–9.
- 24. Sérégé H. Contribution à létude de la circulation du sang porte dans le foie et des localizations lobaires hepatiques. J méd Bordeaux 1901;31:271-312.
- 25. Moore GE, Bridenbaugh RB. Roentgen demonstration of the venous circulation in the liver; portal venography. Radiology 1951;57:685–90.
- 26. Ambrosetti MC, Zamboni GA, Mucelli RP. Distribution of liver metastases based on the site of primary pancreatic carcinoma. Eur Radiol [Internet]. 2016;26:306–10.
- 27. Shirai Y, Wakai T, Ohtani T, Sakai Y, Tsukada K, Hatakeyama K. Colorectal carcinoma metastases to the liver. Does primary tumor location affect its lobar distribution? Cancer 1996;77:2213-6.
- 28. Falconer CWA, Griffiths E. The anatomy of the blood-vessels in the region of the pancreas. Br J Surg 1950;37:334–44.
- 29. Aktan ZA, Govsa F, Hancl IH, Karadeniz Z, Ozgur T, Ege B. An anatomic study on the portal vein formation. Medical J Eng University 1995; 5: 5-8.
- 30. Nelson RC, Chezmar JL, Sugarbaker PH, Murray DR, Bernardino ME. Preoperative localization of focal liver lesions to specific liver segments: utility of CT during arterial portography. Radiology 1990;176:89–94.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 15 Ocak 2024 |
| Yayımlanma Tarihi | 1 Ocak 2024 |
| Gönderilme Tarihi | 8 Haziran 2022 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 10 Sayı: 1 |
