[The importance of the I-colic time in colorectal cancer with synchronous hepatic metastases. Specifics of surgical strategy].
OBJECTIVE
This paper proposes the presentation of a decision-making algorithm in colorectal cancer with synchronous hepatic metastases, as stressing the importance of I-colic time in obtaining the R0 desideratum.


METHODS
There is no worldwide consensus regarding the surgical attitude in metastatic colorectal cancer. There are some predominantly conservative attitudes which use stenting and neoadjuvant chemotherapy followed by periodical re-evaluation or more aggressive surgical treatment. In the pertinent literature, emphasis is on surgery in two stages, on the separation of the colic stage from the hepatic one, the majority proposing stage one cholic and stage two hepatic, thus there are also situations in which the liver may be dealt with from the first intention.


RESULTS
We propose to present, taking the examples from clinical cases, the main techniques of dealing with the cases of metastatic colorectal cancer, stressing personal attitude: aggressive surgery in a short step, which is either radical or creates the conditions for a step II radical one.


CONCLUSIONS
In our vision the liver is the key to the surgical treatment in metastatic colorectal cancer and we must take into account from the first step through interventions with radical intent any time it is possible or through other operations: ligature of portal branch, partial hepatectomies, unilateral local destruction, preparing the way to radical step II.
Moldovan
B
B
Clinica Chirurgie I, Spitalul Clinic Judeţean de Urgenţă Tg-Mures, U.M.E Tg-Mures. moldovanb@hotmail.com
Copotoiu
C
C
Bud
V
V
Nemes
I
I
Serac
G
G
Molnar
C
C
Florea
Sabina
S
Cornăteanu
Sorina
S
Milutin
Doina
D
Coţovanu
A
A
Pocreaţă
D
D
D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012086:Reoperation; D016896:Treatment Outcome