Technique of vessel-skeletonized parenchyma-sparing hepatectomy for the oncological treatment of bilobar colorectal liver metastases.
Technique of vessel-skeletonized parenchyma-sparing hepatectomy for the oncological treatment of bilobar colorectal liver metastases.
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DOI：
10.1007/s00423-021-02373-9
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Fujiwara T
中科院分区：
文献类型：
--
作者：
Umeda Y;Nagasaka T;Takagi K;Yoshida R;Yoshida K;Fuji T;Matsuda T;Yasui K;Kumano K;Sato H;Yagi T;Fujiwara T
为了帮助多发性双叶结直肠肝转移瘤（CRLM）的肿瘤学治疗，我们描述了一种新的外科手术，VESPAH（VESPAH）。在接受肝切除术治疗的152例CRLM患者中，33例患者有多发性双叶肝转移（≥ 8个肝转移）;回顾性总结了他们的手术程序和临床结局，并比较了接受VESPAH和接受大肝切除术（Major Hx）的患者。在33例患者中，20例患者通过VESPAH（VESPAH组）切除，13例患者通过肝大部切除术（Major Hx组）切除。VESPAH组CRLM的中位数量为13（范围，8 - 53），严重Hx组为10（范围，8 - 41）（P = 0.511）。两组均未观察到手术死亡率或严重发病率。VESPAH组术后残余肝功能恢复早于重度Hx组; VESPAH组肝切除术后B/C级肝衰竭的发生率为5%，重度Hx组为38%，P = 0.048）。VESPAH组和重度Hx组分别有14例（70%）和7例（54%）患者证实肝内肿瘤复发（P = 0.416）。两组肝切除术后的中位总生存期（OS）无显著差异; VESPAH组的中位OS为47个月，重度Hx组为33个月（P = 0.481）。VESPAH组术后2个月内辅助化疗的诱导率（P = 0.002）和因肝内复发而重复肝切除术的总次数（P = 0.060）均高于Major Hx组。VESPAH使我们能够通过肝血管重建来清除手术导航，并且不仅可以提高患者对辅助化疗的耐受性，还可以提高患者一生中重复肝切除术的耐受性。在线版本包含补充材料，可通过10.1007/s00423 - 021 - 02373 - 9获得。
To aid in the oncological management of multiple bilobar colorectal liver metastases (CRLMs), we describe a new surgical procedure, VEssel-Skeletonized PArenchyma-sparing Hepatectomy (VESPAH). Of 152 patients with CRLMs treated with hepatectomy, 33 patients had multiple bilobar liver metastases (≥8 liver metastases); their surgical procedures and clinical outcomes were retrospectively summarized and compared between those who underwent VESPAH and those who underwent major hepatectomy (Major Hx). Of the 33 patients, 20 patients were resected by VESPAH (the VESPAH group) and 13 patients by major hepatectomy (Major Hx group). The median number of CRLMs was 13 (range, 8–53) in the VESPAH group and 10 (range, 8–41) in the Major Hx group (P=0.511). No operative mortality nor severe morbidity was observed in either group. The VESPAH group showed earlier recovery of remnant liver function after surgery than the Major Hx group; the incidence of grade B/C post hepatectomy liver failure was 5% in the VESPAH group and 38% in the Major Hx group, P=0.048). Intrahepatic tumor recurrence was confirmed in 14 (70%) and 7 (54%) patients in the VESPAH and Major Hx groups, respectively (P=0.416). There was no significant difference in median overall survival (OS) after hepatectomy between the two groups; the median OS was 47 months in the VESPAH group and 33 months in the Major Hx group (P=0.481). The VESPAH group showed the higher induction rate of adjuvant chemotherapy within 2 months after surgery (P=0.002) and total number of repeat hepatectomy for intrahepatic recurrence (P=0.060) than the Major Hx group. VESPAH enables us to clear surgical navigation by hepatic vessel skeletonization and may enhance patient tolerability of not only adjuvant chemotherapy but also repeat hepatectomies during the patients’ lifetimes. The online version contains supplementary material available at 10.1007/s00423-021-02373-9.
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