Zubarev N. Optimization of treatment of patients with colorectal cancer metastases to the liver.

Modern management and new solutions of treatment optimization for patients with colorectal cancer (CRC) and liver metastases are presented in the dissertation. These innovations were achieved by means of application of modern diagnostic techniques and complex treatment, namely hepatic resection, radiofrequency thermal ablation and chemotherapy. The research has been divided into 2 stages. Efficacy of modern diagnostic methods of colorectal liver metastases was studied at the stage 1. The efficacy analysis has been carried out based on results of investigation of 142 patients with CRC and with suspicion or presence of Mts in a liver which are presented as 539 descriptions and corresponding conclusions of such diagnostic methods as US, CT scanning, percutaneous biopsy, CЕА levels. As a result of this study it has been concluded that modern diagnostic methods are highly efficient in hepatic Mts detection. Therefore we developed the diagnostic schema which enables the efficient detection of Mts in a liver in patients with CRC and improvement of further planning of treatment tactics. The analysis of surgical and combined treatment, chemotherapy, symptomatic treatment and follow-up on 127 patients with CRC and liver Mts was made at the stage 2. Also comparison of efficacy of these treatment methods was made. Immediate and long-term results of treatment have been estimated. As a result of this study further statements have been revealed: 1) combined treatment of patients with CRC and liver Mts in volume of hepatic resection and postoperative chemotherapy is the most effective method in comparison with chemotherapy and a symptomatic therapy; 2) synchronic hepatic resection provides better long-term results in comparison with two-staged and independent resections; 3) it was possible to convert unresectable liver Mts into resectable due to systemic chemotherapy in 7,14 % of cases.