Changes In The Microvascular Architecture Of Colorectal Livermetastases And Clinicaloutcomes Analysis

Part Ⅰ:Changes in the Microvascular Architecture of Colorectal Liver MetastasesObjective:To research the changes in the microvascular architecture of colorectal liver metastases. Provide theoretical basis for colorectal liver metastases clinical treatments.Methods:The donations of20cases of liver fresh bodies as the research object, All participants for clinical diagnosis by colorectal liver metastases, with detailed clinical images data. All Metastases without surgical resection or intervention treatment. After liver perfusion with Physiological saline, Infusion hepatic artery, the portal and bile duct use different color of the resin. Corrode the livers after the success of the infusion. Locate interest area(tumor centre and periphery). Observe the changes in the microvascular architecture.Results:This paper is composed of20patients with colorectal liver metastases specimens, A total of64tumor can be measured, Among them23more than3cm in diameter,41less than3cm. Tumor can be divided into:a single nodular, nodules are visible type, diffuse type. Among them more than3cm of cancer mainly hepatic artery blood supply, Less than3cm of cancer give priority to portal vein blood supply(p=0.004). Scanning electron microscopy presentation:Colorectal liver metastases microvascular structure form complex, Mainly divided into:true loops, bifurcate,spiral and capillary networks. And different tumor diameter, Its microvascular diameter statistics have significant differences(p=0.038,0.012).Conclusion:Different diameters of colorectal liver metastases have different sources of the blood supply of liver, different Microvascular Architecture and we should taken different treatment in clinical. PartⅡ:The Clinical Response and Outcomes of Neoadjuvant Systemic Chemotherapy for Resectable Colorectal Liver MetastasesObjective:To investigate the feasibility and long term outcome of neoadjuvant chemotherapy prior to hepatectomy in patients with resectable colorectal liver metastases.Methods:Fifty-seven patients with colorectal cancer liver metastases were divided into A, B groups.group A:preoperative neoadjuvant chemotherapy, a total of23cases, group B: Nonpreoperative chemotherapy, a total of34cases. CompResults:There were no deaths within30days of surgery. Where the number of blood transfusion, hospital stay, bile leakage in the group A was significantly higher than that in group B. Respiratory complications, including pleural effusion, pneumonia, respiratory failure, ARDS, circulatory complications, including heart failure, liver failure no significant difference between the two groups.1,3,5-year survival rate of group A was:83.3%,60.2%,37.5%. It was84.8%,68.2%,32.5%in group B respectively, all no difference in both groups (all P>0.05)Conclusion:The preoperative evaluation of patients with resectable liver metastases, no surgical contraindications, such as direct surgical treatment, so that complications can be reduced accordingly. PartⅢ:Simultaneous liver and colorectal resection for synchronous central colorectal liver metastasis:a report of23cases.Objective:To investigate the feasibility and long term outcome of simultaneous liver and colorectal resection for central synchronous colorectal liver metastasis.Methods:23synchronous colorectal liver metastasis patients who received simultaneous colectomy and hepatectomy between January1999and November2010were analyzed retrospectively.Results:The group included16male patients and7female patients, with the age from34to68years. The overall median operative time was306±72minutes,6cases received blood transfusion, The median hospital stay was11.4±1.8days. The morbidity and mortality was30.4%(7/23) and0%,respectively.1.3.5-year survival rate was74.0%,48.5%,17.0%.Conclusions:Simultaneous liver and colorectal resection is safe and effective for synchronous central colorectal liver metastasis. Part Ⅳ:regional hepatic vascular exclusion in Simultaneous liver and colorectal resection for synchronous central colorectal liverObjective:To evaluate the regional hepatic vascular exclusion in Simultaneous liver and colorectal resection for synchronous central colorectal liver.Methods:21synchronous colorectal liver metastasis patients who received simultaneous colectomy and hepatectomy with regional hepatic vascular exclusion between January2005and November2010were analyzed retrospectively.Results The overall median operative time was243±82minutes, blood transfusion is285±104ml4cases received blood transfusion. The median hospital stay was8.9±2.1days. respectively.1.3.5-year survival rate was80.3%,51.3%,29.6%.Conclusions Regional hepatic vascular exclusion is a safe and feasible method in the procedure of simultaneous liver and colorectal resection for central synchronous colorectal liver metastasis.