Outcomes of intensive surveillance after resection of hepatic colorectal metastases
Outcomes of intensive surveillance after resection of hepatic colorectal metastases
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DOI：
10.1002/bjs.7136
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发表时间：
2010-10-01
影响因子：
9.6
通讯作者：
Prasad, K. R.
中科院分区：
文献类型：
--
作者：
Gomez, D.;Sangha, V. K.;Prasad, K. R.
背景：评估了基于计算机断层扫描 (CT) 的随访对检测结直肠肝转移 (CRLM) 手术后可切除疾病复发的影响。方法：纳入了 1993 年 1 月至 2007 年 3 月期间接受 CRLM 切除术的约 705 名患者。监测包括术后前 2 年每月 3 次 CT（胸部、腹部和骨盆），3 年每月 6 次，第 6 至 10 年每年一次。确定手术治疗和姑息治疗患者复发后的生存率差异，并计算费用。结果：五年无病生存率和总生存率分别为 28.3% 和 32.3%。在 2 年内出现复发的 402 名患者中，88 名接受单纯肝切除治疗，36 名接受肺和/或肝脏切除治疗。他们的 5 年总体生存率分别为 31% 和 30%，而 278 名姑息治疗患者的 5 年总体生存率为 3.9%（P < 0.001）。在第一年的随访中，每三个月间隔一次，接受手术治疗的复发患者的总生存期优于姑息治疗的患者。确定 124 名适合进一步切除的患者的监测费用为每次手术复发 12 英镑 338。假设复发患者获得了 5 年生存期，则每次切除平均生存期增加为 4.28 年，每生命年增加的成本为 2883 英镑。结论：CRLM 肝切除术后每月进行 3 个月的强化 CT 监测可发现相当多的患者存在复发，且适合进一步切除。这些患者的生存率显着提高，每延长生命年的成本也合理。
Background: The impact of computed tomography (CT)-based follow-up for the detection of resectable disease recurrence following surgery for colorectal liver metastases (CRLM) was evaluated.Methods: Some 705 patients undergoing resection of CRLM between January 1993 and March 2007 were included. Surveillance comprised 3-monthly CT (thorax, abdomen and pelvis) in the first 2 years after surgery, 6 monthly for 3 years and annually from years 6 to 10. Survival differences following recurrence between patients managed surgically and palliatively were determined, and the cost was calculated.Results: Five-year disease-free and overall survival rates were 28.3 and 32.3 per cent respectively. Of 402 patients who developed recurrence within 2 years, 88 were treated with liver resection alone and 36 with lung and/or liver resection. Their 5-year overall survival rates were 31 and 30 per cent respectively, compared with 3.9 per cent in 278 patients managed palliatively (P < 0.001). For each 3-month interval during the first year of follow-up, patients with recurrence treated surgically had better overall survival than those treated palliatively. The cost of surveillance that identified 124 patients amenable to further resection was 12 pound 338 per operated recurrence. Assuming that patients with recurrence gained 5 years' survival, the mean survival gain was 4.28 years per resection and the cost per life-year gained was 2883 pound.Conclusion: Intensive 3-monthly CT surveillance after liver resection for CRLM detects recurrence that is amenable to further resection in a considerable number of patients. These patients have significantly better survival with a reasonable cost per life-year gained.