Population level outcomes and costs of single stage colon and liver resection versus conventional two-stage approach for the resection of metastatic colorectal cancer
Population level outcomes and costs of single stage colon and liver resection versus conventional two-stage approach for the resection of metastatic colorectal cancer
复制标题
DOI：
10.1016/j.hpb.2018.08.007
复制
发表时间：
2019-04-01
期刊：
影响因子：
2.9
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Idrees, Jay J.;Bagante, Fabio;Pawlik, Timothy M.
背景：本研究的目的是比较联合结肠(CR)和肝切除(LR)治疗同时发生结直肠癌肝转移(CRLM)的患者和接受两期CR和LR治疗的患者的预后。结果：83 410例患者中，CR+LR 5659例(6.7%)，C+LR 5659例(6.7%)，单纯CR+LR分别为70例、177例(84.0%)和7574例(9.3%)。接受CR+LR的患者数量从2004年的423人增加到2014年的580人(Delta=+37%)。与接受二期CR和LR的患者相比，接受CR+LR的患者术后发病率较低(CR+LR与两期CR和LR：38.5%比61.2%)，LOS较短(中位LOS：8天[IQR：7-12]比14天[IQR：10-21])，术后死亡率较低(3.1%比5.9%)。与接受两期CR和LR的患者相比，接受CR+LR的患者的中位住院费用低13,093美元(中位成本：36,775美元[IQR：26,416-54,245]比23,682美元[IQR：16,299-32,996])。与两期完全缓解和完全缓解相比，完全缓解+完全缓解可改善预后，降低治疗费用。
Background: The objective of the current study was to compare outcomes among patients combined colon (CR) and liver resection (LR) for the treatment of simultaneous colorectal liver metastasis (CRLM) versus patients undergoing two-stage CR and LR.Methods: Patients undergoing surgery for CRLM between 2004 and 2014 were identified using the Nationwide Inpatient Sample (NIS). Propensity-score matching was used to compare patients undergoing CR + LR with patients undergoing two-stage CR and LR.Results: Among 83,410 patients, CR + LR was performed in 5659 (6.7%), stage C + LR was performed in 5659 (6.7%), while isolated CR and LR was performed in 70,177 (84.0%) and 7574 (9.3%) patients, respectively. The number of patients undergoing CR + LR increased from 423 in 2004 to 580 in 2014 (Delta = +37%). Patients undergoing CR + LR had lower postoperative morbidity (CR + LR vs. two-staged CR and LR: 38.5% vs. 61.2%), shorter LOS (median LOS: 8 days [IQR: 7-12] vs. 14 days [IQR: 10-21]), and lower postoperative mortality (3.1% vs. 5.9%) versus patients undergoing two-stage CR and LR. Compared with patients undergoing two-staged CR and LR, median hospital costs were $13,093 lower for patients undergoing CR + LR (median costs: $36,775 [IQR: 26,416-54,245] vs. $23,682 [IQR: 16,299-32,996]).Conclusion: CR + LR was increasingly performed for treatment of CRLM. Compared with two-staged CR and LR, CR + LR was associated with improved outcomes and lower costs.