Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases
Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases
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DOI：
10.1097/01.sla.0000128305.90650.71
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发表时间：
2004-06-01
影响因子：
9
通讯作者：
Curley, SA
中科院分区：
文献类型：
--
作者：
Abdalla, EK;Vauthey, JN;Curley, SA
目的：检查仅接受肝切除、射频消融 (RFA) 加切除或仅 RFA 治疗结直肠肝转移的患者的复发率和生存率。背景数据摘要：热破坏技术，特别是 RFA，在过去 5 年中已迅速被外科实践所接受。缺乏使用 RFA 联合或不联合肝切除治疗结直肠肝转移后的长期生存数据。方法：对 358 名连续接受肝切除+/- RFA 治疗的结直肠肝转移患者和 70 名在剖腹手术中发现仅有肝脏疾病但不适合接受潜在治愈性治疗的患者的数据进行比较（1992-2002 年）。结果：在 418 名接受治疗的患者中， 190 例（45%）仅接受切除术，101 例 RFA + 切除术（24%），57 例仅 RFA（14%），70 例剖腹手术仅活检或动脉输液泵放置（“仅化疗”，17%）。 RFA 用于无法完全切除病变的手术候选者。 RFA 后总体复发最常见（84% vs. 64% RFA + 切除 vs. 52% 仅切除，P < 0.001）。 RFA 后仅肝脏复发的比率是切除后的四倍（44% vs. 11% 患者，P < 0.001），并且 RFA 后最常见的是真正的局部复发（9% 患者 vs. 5% RFA + 切除 vs. 2% 切除，P = 0.02）。切除后总生存率最高（5 年时为 58%）；切除、RFA + 切除和仅 RFA 后 4 年生存率分别为 65、36% 和 22%（P < 0.0001）。接受 RFA + 切除或仅 RFA 治疗的“不可切除”患者的生存率高于仅化疗 (P = 0.0017)。结论：肝切除术是结直肠肝转移的首选治疗方法。对于无法切除的患者，单独使用 RFA 或与切除术联合使用并不能提供与切除术相当的生存率，仅提供略优于非手术治疗的生存率。
Objective: To examine recurrence and survival rates for patients treated with hepatic resection only, radiofrequency ablation (RFA) plus resection or RFA only for colorectal liver metastases.Summary Background Data: Thermal destruction techniques, particularly RFA, have been rapidly accepted into surgical practice in the last 5 years. Long-term survival data following treatment of colorectal liver metastasis using RFA with or without hepatic resection are lacking.Methods: Data from 358 consecutive patients with colorectal liver metastases treated for cure with hepatic resection +/- RFA and 70 patients found at laparotomy to have liver-only disease but not to be candidates for potentially curative treatment were compared (1992-2002).Results: Of 418 patients treated, 190 (45%) underwent resection only, 101 RFA + resection (24%), 57 RFA only (14%), and 70 laparotomy with biopsy only or arterial infusion pump placement ("chemotherapy only," 17%). RFA was used in operative candidates who could not undergo complete resection of disease. Overall recurrence was most common after RFA (84% vs. 64% RFA + resection vs. 52% resection only, P < 0.001). Liver-only recurrence after RFA was fourfold the rate after resection (44% vs. 11% of patients, P < 0.001), and true local recurrence was most common after RFA (9% of patients vs. 5% RFA + resection vs. 2% resection only, P = 0.02). Overall survival rate was highest after resection (58% at 5 years); 4-year survival after resection, RFA + resection and RFA only were 65 36%, and 22%, respectively (P < 0.0001). Survival for "unresectable" patients treated with RFA + resection or RFA only was greater than chemotherapy only (P = 0.0017).Conclusions: Hepatic resection is the treatment of choice for colorectal liver metastases. RFA alone or in combination with resection for unresectable patients does not provide survival comparable to resection, and provides survival only slightly superior to nonsurgical treatment.