Anatomical Versus Nonanatomical Resection of Colorectal Liver Metastases: Is There a Difference in Surgical and Oncological Outcome?
Anatomical Versus Nonanatomical Resection of Colorectal Liver Metastases: Is There a Difference in Surgical and Oncological Outcome?
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DOI：
10.1007/s00268-010-0890-9
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发表时间：
2011-03-01
影响因子：
2.6
通讯作者：
Verhoef, Cornelis
中科院分区：
文献类型：
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作者：
Lalmahomed, Zarina S.;Ayez, Ninos;Verhoef, Cornelis
随着结直肠肝转移（CLM）患者复发的新辅助化疗和微创治疗的使用增加，使得尽可能多地节省肝脏体积的手术策略变得至关重要。在这项研究中，我们确定了接受解剖性肝切除术（AR）和非解剖性肝切除术（NAR）治疗的CLM患者发病率和死亡率以及复发和生存模式的差异。从2000年1月到2008年6月，接受了切除术的CLM患者被纳入并分为两组：接受AR的患者和接受NAR的患者。除手术外同时接受射频消融的患者和肝外转移的患者被排除。比较患者、肿瘤和治疗数据，以及无病生存期和总生存期 (OS)。88 名患者 (44%) 接受了 AR，113 名患者 (56%) 接受了 NAR。对显着较小的转移进行 NAR（3 与 4 厘米，P < 0.001）。各组之间的临床风险评分没有差异。 NAR 后，患者接受的输血次数显着减少（20% vs. 36%，P = 0.012），住院时间显着缩短（7 天 vs. 8 天，P < 0.001）。并发症、切缘阳性或复发方面没有显着差异。对于整个研究组，估计的 5 年无病生存率和 OS 分别为 31% 和 44%，各组之间没有差异。我们的研究结果表明，根据切除类型，发病率、死亡率、复发率或生存率没有显着差异。 NAR 可用作保存肝实质的保存程序。
The increased use of neoadjuvant chemotherapy and minimally invasive therapies for recurrence in patients with colorectal liver metastases (CLM) makes a surgical strategy to save as much liver volume as possible pivotal. In this study, we determined the difference in morbidity and mortality and the patterns of recurrence and survival in patients with CLM treated with anatomical (AR) and nonanatomical liver resection (NAR).From January 2000 to June 2008, patients with CLM who underwent a resection were included and divided into two groups: patients who underwent AR, and patients who underwent NAR. Patients who underwent simultaneous radiofrequency ablation in addition to surgery and patients with extrahepatic metastasis were excluded. Patient, tumor, and treatment data, as well as disease-free and overall survival (OS) were compared.Eighty-eight patients (44%) received AR and 113 patients (56%) underwent NAR. NAR were performed for significant smaller metastases (3 vs. 4 cm, P < 0.001). The Clinical Risk Score did not differ between the groups. After NAR, patients received significantly less blood transfusions (20% vs. 36%, P = 0.012), and the hospital stay was significantly shorter (7 vs. 8 days, P < 0.001). There were no significant differences in complications, positive resection margins, or recurrence. For the total study group, estimated 5-year disease-free and OS was 31 and 44%, respectively, with no difference between the groups.Our study resulted in no significant difference in morbidity, mortality, recurrence rate, or survival according to resection type. NAR can be used as a save procedure to preserve liver parenchyma.