Does Anatomic Versus Nonanatomic Resection Affect Recurrence and Survival in Patients Undergoing Surgery for Colorectal Liver Metastasis?
Does Anatomic Versus Nonanatomic Resection Affect Recurrence and Survival in Patients Undergoing Surgery for Colorectal Liver Metastasis?
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DOI：
10.1245/s10434-008-0218-2
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发表时间：
2009-02-01
影响因子：
3.7
通讯作者：
Labow, Daniel M.
中科院分区：
文献类型：
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作者：
Sarpel, Umut;Bonavia, Anthony S.;Labow, Daniel M.
结直肠癌肝转移的解剖切除可能提供生存优势，因为(1)它作为一个整体去除了肝功能单位，(2)据报道，非解剖切除具有更高的阳性边缘发生率。183名患者符合接受解剖或非解剖切除的纳入标准，目的是消除所有肉眼疾病。平均年龄61岁(31~90岁)，男性占57%。非解剖切除89例(49%)，解剖切除94例(51%)。血流阻断时间平均为10min。平均住院时间为7.4天。有3人死亡，30天死亡率为1.6%。切缘阳性的发生率在不同的切除类型之间没有差异。1年、3年和5年的复发率分别为27%、55%和59%。1、3、5年总生存率分别为%、67%、55%。即使在调整了术前风险的差异后，切除的类型与复发或生存率的差异也没有显著关系。我们得出结论，肝切除治疗结直肠转移瘤是安全的，并可为精选的IV期疾病患者提供延长生存的机会。切除类型应根据肿瘤的数目和位置，而不是节段性解剖。在化疗相关性脂肪性肝炎和越来越多的患者接受重复转移切除的情况下，强调肝实质的保存可能变得越来越重要。
Anatomic resection of colorectal liver metastases may offer a survival advantage because (1) it removes the hepatic functional unit as a whole and (2) nonanatomic resection has been reported to have a higher incidence of positive margins.A retrospective review was performed of patients undergoing hepatic resection for colorectal liver metastases. 183 patients met inclusion criteria of undergoing either anatomic or nonanatomic resection with the aim of removing all gross disease. Mean age was 61 years (range 31-90 years), 57% were male. 89 patients (49%) underwent nonanatomic resection, the remaining 94 (51%) had anatomic resection. Average duration of inflow occlusion was 10 min. Average length of stay was 7.4 days. There were three deaths, yielding a 1.6% 30-day mortality rate. There was no difference in the incidence of positive margins between types of resection. Recurrence was 27%, 55%, and 59% at 1, 3, and 5 years respectively. Overall survival was 89%, 67%, and 55% at 1, 3, and 5 years, respectively. Type of resection was not associated with significant differences in recurrence or survival even when adjusted for differences in preoperative risk.We conclude that hepatic resection for colorectal metastases can be performed safely and offers select patients with stage IV disease prolonged survival. Resection type should be based on the number and location of tumors, rather than on segmental anatomy. An emphasis on the preservation of hepatic parenchyma may be of increasing importance in the setting of chemotherapy-associated steatohepatitis, and the growing number of patients undergoing repeated metastasectomy.