Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases
Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases
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DOI：
10.1002/bjs.7106
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发表时间：
2010-08-01
影响因子：
9.6
通讯作者：
Castaing, D.
中科院分区：
文献类型：
--
作者：
de Haas, R. J.;Adam, R.;Castaing, D.
背景：同步结直肠癌肝转移(CLMS)患者的最佳手术策略仍不清楚。本研究的目的是比较有限肝切除(少于三个节段)患者同时行结直肠和肝切除和延迟切除的效果。方法：对1990-2006年间所有接受有限肝切除的同步CLMS患者进行回顾。结果：228例肝切除同期CLMS患者中，55例(24.1%)同时行结直肠切除，173例(75.9%)行延迟肝切除。两组肝切除术后死亡率相似(0比0.6%；P=0.557)，但同期组累积发病率显著低于延迟组(11%比25.4%；P=0.015)。同步组的3年总生存率和无进展生存率分别为74%和8%，而延迟组分别为70.3%和26.1%(总生存率：P=0.871；无进展生存率：P=0.005)。同期组3年复发率显著高于同期组(85%对63.6%；P=0.002)；同时策略是复发的独立预测因素。结论：结直肠癌切除联合有限肝切除对同步CLMS患者是安全的，与延迟手术相比，累积发病率较低。然而，联合治疗对无进展生存有负面影响。
Background: The optimal surgical strategy for patients with synchronous colorectal liver metastases (CLMs) is still unclear. The aim of this study was to compare simultaneous colorectal and hepatic resection with a delayed strategy in patients who had a limited hepatectomy (fewer than three segments).Methods: All patients with synchronous CLMs who underwent limited hepatectomy between 1990 and 2006 were included retrospectively. Short-term outcome, overall and progression-free survival were compared in patients having simultaneous colorectal and hepatic resection and those treated by delayed hepatectomy.Results: Of 228 patients undergoing hepatectomy for synchronous CLMs, 55 (24.1 per cent) had a simultaneous colorectal resection and 173 (75.9 per cent) had delayed hepatectomy. The mortality rate following hepatectomy was similar in the two groups (0 versus 0.6 per cent respectively; P = 0.557), but cumulative morbidity was significantly lower in the simultaneous group (11 per cent versus 25.4 per cent in the delayed group; P = 0.015). Three-year overall and progression-free survival rates were 74 and 8 per cent respectively in the simultaneous group, compared with 70.3 and 26.1 per cent in the delayed group (overall survival: P = 0.871; progression-free survival: P = 0.005). Significantly more recurrences were observed in the simultaneous group at 3 years (85 versus 63.6 per cent; P = 0.002); a simultaneous strategy was an independent predictor of recurrence.Conclusion: Combining colorectal resection with a limited hepatectomy is safe in patients with synchronous CLMs and associated with less cumulative morbidity than a delayed procedure. However, the combined strategy has a negative impact on progression-free survival.