Impact of the strategy for curative treatment of synchronous colorectal cancer liver metastases
Impact of the strategy for curative treatment of synchronous colorectal cancer liver metastases
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DOI：
10.1016/j.jviscsurg.2019.10.007
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发表时间：
2020-08-01
影响因子：
2.1
通讯作者：
Muscari, F.
中科院分区：
文献类型：
--
作者：
Raoux, L.;Maulat, C.;Muscari, F.
研究目的：14%至17%的结直肠癌患者在诊断时有同步性肝转移（sCRLM）。目前有三种可能的策略用于sCRLM的治愈性管理：“经典”、“联合”和“肝脏优先”。我们研究的目的是分析sCRLM的三种手术治疗策略对术后发病率和死亡率以及总体和无复发生存率的影响。患者和方法：纳入了2000年10月至2015年5月期间接受sCRLM治疗的患者。我们定义了三个组：（1）“经典”：结果：170例患者共行209次肝切除术（“经典”149例，“联合”34例，“肝脏优先”26例）。“联合”组的严重并发症发生率高于“经典”组（35% vs. 12%，P=0.03）和“肝脏优先”组（35% vs. 19%，P=0.25），而肝脏切除术明显较少。在我们的队列中，5年的总生存率为46%，组间无显著差异，中位生存期为54个月。在我们的队列中的患者的无复发生存率为24%，在5年，中位生存时间为14个月，无复发，groups.Conclusion之间没有显着差异：所有这三种策略是可行的，并有没有差异的总体和无复发生存之间的三种方法。“联合”策略组有更严重的并发症，尽管侵袭性肝病较少，肝切除术更有限，但没有提供更好的肿瘤学结果。(C)2019 Elsevier Masson SAS。All rights reserved.
Aim of the study: Fourteen to seventeen percent of patients suffering from colorectal cancer have synchronous liver metastases (sCRLM) at the time of diagnosis. There are currently three possible strategies for curative management of sCRLM: "classic", "combined", and "liver first". The aim of our research was to analyze the effects of the three surgical management strategies for sCRLM on postoperative morbidity and mortality and overall and recurrence-free survival.Patients and Methods: Patients treated for sCRLM between October 2000 and May 2015 were included. We defined three groups: (1) "classic": surgery of primary tumor and then surgery of sCRLM; (2) "combined": combined surgery of primary tumor and sCRLM: and (3) "liver-first": surgery of sCRLM and then surgery of primary tumor.Results: During this period, 170 patients who underwent 209 hepatectomies were included ("classic": 149, "combined": 34, "liver-first": 26). The rate of severe complications was higher in the "combined" group compared to the "classic" group (35% vs. 12%, P=0.03), and the "liver -first" group (35% vs. 19%, P=0.25), while there were significantly fewer liver resections. Overall survival at 5 years in our cohort was 46%, without significant differences between the groups, and a median survival of 54 months. Recurrence-free survival of the patients in our cohort was 24% at 5 years, with a median survival time without recurrence of 14 months, without significant differences between the groups.Conclusion: All three strategies were feasible and there were no differences regarding overall and recurrence-free survivals between the three approaches. The "combined" strategy group had significantly more severe complications and did not provide better oncological results, despite less aggressive liver disease and more limited liver resections. (C) 2019 Elsevier Masson SAS. All rights reserved.