Blood loss and outcomes after resection of colorectal liver metastases
Blood loss and outcomes after resection of colorectal liver metastases
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DOI：
10.1016/j.jss.2016.01.020
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发表时间：
2016-05-15
影响因子：
2.2
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Margonis, Georgios A.;Kim, Yuhree;Pawlik, Timothy M.
背景：术中出血量（IBL）对结肠直肠癌肝转移（CRLM）行肝切除术患者长期预后的影响尚未明确。材料和方法：2000年至2013年期间，共有433名在约翰霍普金斯大学接受治疗目的肝切除术的CRLM患者被确定。收集和分析了人口统计学、IBL数据和长期结果。评估IBL的临床病理预测因素以及IBL与预后的关系。结果：患者年龄中位数为54岁（四分位数范围44 ~ 64岁），男性居多（58.9%,n = 255）。手术时，中位IBL为400 mL（范围10-5100 mL）。在多因素分析中，与IBL （>250 mL）增加相关的因素为男性（优势比[OR]为2.62；95%可信区间[CI]为1.68-4.09;P < 0.001）、肿瘤大小>3 cm （OR, 1.88； 95% CI为1.18-2.99;P = 0.008）和肝切除术（OR, 3.08； 95% CI为1.92-4.92;P < 0.001）。在30.6个月的中位随访时间中，IBL < 250、250-1000和> 1000 mL患者的中位生存时间分别为70.5、56.4和36.9个月（P = 0.004）。在多因素分析中，校正输血等其他因素后，IBL > 250ml仍然是总生存的独立预后因素（危险比1.41;95% CI, 1.01-1.97; P = 0.04）。结论：CRLM切除术中IBL的大小与肿瘤的生物学特性和手术范围有关。CRLM切除术期间IBL增加是患者生存恶化的独立预后因素。此外，IBL增加和生存恶化之间的剂量-反应关系是明显的。(C) 2016 Elsevier Inc.版权所有。
Background: The influence of intraoperative blood loss (IBL) on long-term outcomes of patients undergoing liver resection for colorectal cancer liver metastases (CRLM) remains not well defined.Materials and methods: A total of 433 patients who underwent curative-intent hepatic resection for CRLM between 2000 and 2013 at Johns Hopkins were identified. Demographics, IBL data, and long-term outcomes were collected and analyzed. Clinicopathologic predictors of IBL and the association of IBL and outcomes were assessed.Results: The median patient age was 54 y (interquartile range, 44-64), most patients were male (58.9%; n = 255). At surgery, the median IBL was 400 mL (range, 10-5100 mL). Two-hundred eighty-seven patients (66.3%) had an IBL of >250 mL. Factors associated with increased IBL (>250 mL) on multivariate analysis were male sex (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.68-4.09; P < 0.001), tumor size >3 cm (OR, 1.88; 95% CI, 1.18-2.99; P = 0.008), and major hepatic resection (OR, 3.08; 95% CI, 1.92-4.92; P < 0.001). At a median follow-up time of 30.6 mo, the median survival times were 70.5, 56.4, and 36.9 mo for IBL < 250, 250-1000, and > 1000 mL, respectively (P = 0.004). IBL > 250 mL remained an independent prognostic factor of overall survival in multivariate analysis (hazard ratio, 1.41; 95% CI, 1.01-1.97; P = 0.04) after adjusting for other factors including the receipt of blood transfusion.Conclusions: The magnitude of IBL during CRLM resection was related to biologic characteristics of the tumor and the extent of surgery. Increased IBL during CRLM resection was an independent prognostic factor for worse patient survival. Furthermore, a dose-response relationship between increasing IBL and worsening survival was evident. (C) 2016 Elsevier Inc. All rights reserved.