Choice of surveillance after hepatectomy for colorectal metastases
Choice of surveillance after hepatectomy for colorectal metastases
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DOI：
10.1001/archsurg.139.7.749
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发表时间：
2004-07-01
影响因子：
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通讯作者：
Maddern, G
中科院分区：
文献类型：
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作者：
Metcalfe, MS;Mullin, EJ;Maddern, G
假设：通过回顾报道的系列，结果与肝切除术后的监测相关吗？设计：我们回顾了 MEDLINE 上索引的从 1990 年 1 月 1 日到 2002 年 12 月 31 日的英语文献。索引术语是肝切除术、结直肠转移瘤和复发与预后、重复、随访或监测的组合。研究选择：包含以下任何数据字段的研究：肝切除术后复发、重复率肝切除术、肝切除术（初次或重复）后 5 年生存率（总体或无病生存）、肝切除术后监测方案以及通过监测方式检测复发。数据提取：数据直接取自少数文章，并汇总各个研究进行分析。我们强调了评估数据质量和有效性的困难，作为对结果解释的警告。结果：肝切除术后复发率为 58%，肝脏复发率为 30%。 9.6% 的病例进行了重复肝切除术。初次和重复肝切除术后的五年生存率分别为 29% 和 38%。许多研究没有报告他们的监测方案。对于那些这样做的人来说，计算机断层扫描或超声检查以及癌胚抗原测量最常构成监测的基础。没有与复发检测、重复肝切除术或生存结果相关的监测技术的数据。结论：本综述证实了重复肝切除术对于复发性疾病的价值，但没有发现支持任何监测方式的直接证据。显然需要进一步的研究，并讨论了这些研究的方法。
Hypothesis: By review of a reported series, is outcome related to surveillance after hepatectomy?Design: We reviewed English-language literature indexed on MEDLINE from January 1, 1990, through December 31, 2002. Indexing terms were combinations of hepatectomy, colorectal metastases, and recurrence with prognostic, repeat, follow-up, or surveillance.Study Selection: Studies containing any of the following data fields were included: recurrence after hepatectomy, rates of repeat hepatectomy, 5-year survival (overall or disease free) after hepatectomy (initial or repeat), posthepatectomy surveillance protocol, and detection of recurrence by surveillance modality.Data Extraction: Data were taken directly from a small number of articles and pooled across studies for analysis. We highlighted difficulties in assessing data quality and validity as a caveat to the interpretation of the results.Results: The rate of recurrence after hepatectomy was 58%, and the rate of hepatic recurrence was 30%. Repeat hepatectomy was performed in 9.6% of cases. Five-year survivals after initial and repeat hepatectomy were 29% and 38%, respectively. Many studies did not report their surveillance protocols. For those that did, computed tomography or ultrasonography with carcinoembryonic antigen measurement most commonly formed the basis of surveillance. No data related surveillance techniques to the outcomes of recurrence detection, repeat hepatectomy, or survival.Conclusions: This review confirmed the value of repeat hepatectomy for recurrent disease, but uncovered no direct evidence supporting any surveillance modalities. Further studies are clearly needed, and approaches to these are discussed.