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Synchronous colorectal liver metastases in pregnancy and post‐partum
Author(s) -
Robson Danielle E.,
Lewin Joel,
Cheng Anthony W.,
O'Rourke Nicholas A.,
Cavallucci David J.
Publication year - 2017
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13196
Subject(s) - medicine , folinic acid , pregnancy , colorectal cancer , oxaliplatin , chemotherapy , obstetrics , surgery , cancer , fluorouracil , biology , genetics
Background Metastatic colorectal cancer (m CRC ) in pregnancy and post‐partum is rare, but represents significant diagnostic and therapeutic challenges for clinicians. A multidisciplinary team ( MDT ) approach is essential. This study reports the first series in the Australasian literature, describing our experience with and management of pregnant and post‐partum patients diagnosed with synchronous colorectal liver metastases (s CRLM ). Method A retrospective review of prospectively collected data for patients with s CRLM diagnosed during pregnancy or post‐partum, presenting to a tertiary referral hospital between 2009 and 2014, was performed. Data regarding patient presentation, imaging, management, histopathology and survival were analysed. Patient characteristics and outcomes were reviewed, including age, presenting complaint and median survival. Results Five patients were identified with s CRLM : three patients were diagnosed antepartum and two post‐partum. Median age was 31 years (range 26–34). All patients were diagnosed with colorectal primary and synchronous liver lesions. All patients received folinic acid, fluorouracil, oxaliplatin chemotherapy, two intrapartum. One patient had both the primary lesion and liver metastases excised early post‐partum. Second‐line chemotherapy with folinic acid, fluorouracil, irinotecan and other biological agents was used in some cases post‐partum. One patient suffered a fetal loss, while the other four had uncomplicated live births. Median survival was 7.6 months, with two patients dying shortly after delivery. Conclusion The diagnosis of m CRC in pregnancy is challenging and survival is poor. A MDT approach to management is essential. Chemotherapy remains the mainstay of treatment from the second trimester. Rapid confirmation of diagnosis and early chemotherapy, followed by post‐partum colorectal and liver resection may improve survival.