Publication: Análisis del volumen esplénico como biomarcador de daño hepático en pacientes con metástasis de cáncer colorrectal tratados con quimioterapia
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2019-01-28
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Universidad Complutense de Madrid
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Abstract
La enfermedad metastásica hepática de cáncer colorrectal (CCR) es un problema clínico importante. El hígado es el órgano metastásico predominante para los pacientes con CCR y el 30 % de los pacientes van a cursar con enfermedad hepática aislada. Los avances en los tratamientos quimioterápicos han mejorado la supervivencia de estos pacientes y los últimos ensayos clínicos reportan una supervivencia media de 30 meses. A pesar de ello, la resección hepática es el tratamiento más eficaz para prolongarla supervivencia a largo plazo, ofreciendo la posibilidad de curación de la enfermedad hepática aislada en pacientes en estadio IV. Así pues, un tratamiento quirúrgico adecuado en combinación con las nuevas quimioterapias, es la mejor opción que podemos ofrecer a este grupo de pacientes en la actualidad. No obstante, el entusiasmo por la quimioterapia sistémica ha sido templado por estudios que la relacionan con daño hepático de tipo esteatohepatitis y daño sinusoidal,después de tratamientos con irinotecán y oxaliplatino. Además, se ha visto una relación significativa entre el daño hepático y la morbimortalidad postoperatoria...
Colorectal liver metastases (CRLM) is an important clinical problem. The liver is the main metastatic organ for patients with colorectal cancer (CRC) and 30% of patients will only evolve with isolated liver disease. Advances in chemotherapy treatments have improved the survival of these patients and the latest clinical trials report an average survival of 30 months. Despite this, hepatic resection is the most effective treatment in order to prolong long-term survival, offering the possibility of cure in selected patients with stage IV liver disease CRC. Thus, adequate surgical treatment in combination with the new chemotherapies is the best option we can offer to this group of patients nowadays. However, the enthusiasm for systemic chemotherapy has been tempered by studies that relate it to liver damage as steatohepatitis and sinusoidal obstruction, after treatments with irinotecan and oxaliplatin. In addition, a significant relationship has been found between liver damage and postoperative morbidity and mortality. The necessity of reliable studies that can diagnose the liver damage is essential to allow an adequate selection of patients candidates for hepatic resection after chemotherapy. In this sense,some current studies suggest that the monitoring of the spleen volume could be considered a biomarker of liver damage and consequently of the morbidity and mortality associated to the surgery...
Colorectal liver metastases (CRLM) is an important clinical problem. The liver is the main metastatic organ for patients with colorectal cancer (CRC) and 30% of patients will only evolve with isolated liver disease. Advances in chemotherapy treatments have improved the survival of these patients and the latest clinical trials report an average survival of 30 months. Despite this, hepatic resection is the most effective treatment in order to prolong long-term survival, offering the possibility of cure in selected patients with stage IV liver disease CRC. Thus, adequate surgical treatment in combination with the new chemotherapies is the best option we can offer to this group of patients nowadays. However, the enthusiasm for systemic chemotherapy has been tempered by studies that relate it to liver damage as steatohepatitis and sinusoidal obstruction, after treatments with irinotecan and oxaliplatin. In addition, a significant relationship has been found between liver damage and postoperative morbidity and mortality. The necessity of reliable studies that can diagnose the liver damage is essential to allow an adequate selection of patients candidates for hepatic resection after chemotherapy. In this sense,some current studies suggest that the monitoring of the spleen volume could be considered a biomarker of liver damage and consequently of the morbidity and mortality associated to the surgery...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 14/09/2017