Repeat Curative Intent Liver Surgery is Safe and Effective for Recurrent Colorectal Liver Metastasis: Results from an International Multi-institutional Analysis
Repeat Curative Intent Liver Surgery is Safe and Effective for Recurrent Colorectal Liver Metastasis: Results from an International Multi-institutional Analysis
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DOI：
10.1007/s11605-009-1050-0
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发表时间：
2009-12-01
影响因子：
3.2
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
de Jong, Mechteld C.;Mayo, Skye C.;Pawlik, Timothy M.
虽然结直肠肝转移切除后5年存活率接近55%，但大多数患者的复发疾病通常是孤立于肝脏的。尽管复发性结直肠癌肝转移的重复治疗性手术(CIS)越来越多，但仅有少量报道。我们试图确定重复CIS治疗复发性结直肠癌肝转移的安全性和有效性，并确定在大型多中心队列患者中预测生存的因素。1982至2008年间，从一个国际多机构数据库中确定了1706名因结直肠癌肝转移接受CIS(定义为治疗性肝切除/射频消融)的患者。246例(14.4%)患者接受了3 0 1次复查。收集和分析临床病理因素、发病率和死亡率的数据。在最初的CIS之后，645例(37.8%)患者在肝脏内复发。在这些患者中，246名患者因复发而接受了重复的CIS。以单纯肝切除为主(n=219，89.0%)。一组患者接受了第三次(n=46)或第四次(n=9)重复CIS。两次手术的平均间隔相似(第一次和第二次，19.1个月；第二次和第三次，21.5个月；第三次和第四次，11.3个月；P=0.20)。肝切除范围随随后的顺应性降低(千分之几)。肝切除：第一顺应性30.9%，第二顺应性21.1%，第三/第四顺应性16.4%；P=0.004)。1/4再次接受CIS的患者使用了RFA(第二个CIS，21.1%；第三/第四个CIS，25.5%)。死亡率和发病率分别在第二、第三和第四个CIS中相似(均P>；0.05)。术后5年生存率分别为47.1%、32.6%和23.8%。肝外疾病的存在预示着较差的生存(HR=2.26，P=0.01)。对于复发的结直肠癌肝转移，重复的CIS可以以较低的发病率和接近于零的死亡率进行。无肝外疾病的患者最有可能再次发生CIS。在这些患者中，重复的CIS可以提供长期生存的机会。
Although 5-year survival approaches 55% following resection of colorectal liver metastasis, most patients develop recurrent disease that is often isolated to the liver. Although repeat curative intent surgery (CIS) is increasingly performed for recurrent colorectal liver metastasis, only small series have been reported. We sought to determine safety and efficacy of repeat CIS for recurrent colorectal liver metastasis as well as determine factors predictive of survival in a large multicenter cohort of patients.Between 1982 and 2008, 1,706 patients who underwent CIS-defined as curative intent hepatic resection/radiofrequency ablation (RFA)-for colorectal liver metastasis were identified from an international multi-institutional database. Two hundred forty-six (14.4%) patients underwent 301 repeat CIS. Data on clinico-pathologic factors, morbidity, and mortality were collected and analyzed.Following initial CIS, 645 (37.8%) patients had recurrence within the liver. Of these, 246 patients underwent repeat CIS for recurrent disease. The majority had hepatic resection alone as initial therapy (n = 219; 89.0%). A subset of patients underwent third (n = 46) or fourth (n = 9) repeat CIS. Mean interval between surgeries was similar (first -> second, 19.1 months; second -> third, 21.5 months; third -> fourth, 11.3 months; P = 0.20). Extent of hepatic resection decreased with subsequent CIS (a parts per thousand yenhemihepatectomy: first CIS, 30.9% versus second CIS, 21.1% versus third/fourth CIS, 16.4%; P = 0.004). RFA was utilized in one quarter of patients undergoing repeat CIS (second CIS, 21.1% versus third/fourth CIS, 25.5%). Mortality and morbidity were similar following second, third, and fourth CIS, respectively (all P > 0.05). Five-year survival was 47.1%, 32.6%, and 23.8% following the first, second, and third CIS, respectively. Presence of extra-hepatic disease was predictive of worse survival (HR = 2.26, P = 0.01).Repeat CIS for recurrent colorectal liver metastasis can be performed with low morbidity and near-zero mortality. Patients with no extra-hepatic disease are best candidates for repeat CIS. In these patients, repeat CIS can offer the chance of long-term survival.