Arru Marcella, Aldrighetti Luca, Ronzoni Monica, Angeli Enzo, Caterini Roberto, Ferla Gianfranco
Unità Operativa di Chirurgia I Istituto Scientifico H San Raffaele, Università Vita-Salute San Raffaele, Milano.
Chir Ital. 2002 Nov-Dec;54(6):811-8.
The aim of the study was to evaluate the effects of preoperative intra-arterial hepatic chemotherapy (IAHC) on the outcome of liver resections for hepatic metastases from colorectal cancer. Twelve patients (IAHC group) treated by IAHC with fluorodeoxyuridine (FUdR) and subsequent liver resection and 40 patients who underwent liver resection without preliminary IAHC (non-IAHC group) were analysed comparatively in terms of age, gender, concomitant diseases, previous abdominal surgery, type of hepatic resection, use of portal clamping, and associated surgical procedures. For the purposes of the study, length of operation, intraoperative blood losses, perioperative transfusions, length of hospitalisation, complications and mortality were also recorded. The two groups were comparable (p = n.s.) for those variables affecting the perioperative course. As regards the end points of the study, no significant differences were recorded in length of operation, intraoperative blood losses, perioperative transfusions [except for more postoperative plasma transfusions in the IAHC group (16.7% vs 5.0%, p = 0.009)] and postoperative complications (9.1% vs 17.5%, p = 0.415). Postoperative mortality consisted in one patient in the IAHC group. Postoperative hospitalization was significantly longer in the non-IAHC group (median: 8 vs 10, range: 6-13 vs 5-33 days; p = 0.004). IAHC does not negatively affect the outcome of subsequent liver resection.
本研究的目的是评估术前肝动脉内化疗(IAHC)对结直肠癌肝转移肝切除术预后的影响。对12例接受氟脱氧尿苷(FUdR)IAHC治疗并随后进行肝切除术的患者(IAHC组)和40例未进行术前IAHC而接受肝切除术的患者(非IAHC组),在年龄、性别、伴随疾病、既往腹部手术史、肝切除类型、门静脉阻断的使用及相关手术操作方面进行了比较分析。为了本研究的目的,还记录了手术时间、术中出血量、围手术期输血情况、住院时间、并发症及死亡率。两组在影响围手术期过程的变量方面具有可比性(p = 无统计学意义)。关于本研究的终点,在手术时间、术中出血量、围手术期输血情况[除IAHC组术后血浆输注更多外(16.7%对5.0%,p = 0.009)]及术后并发症方面(9.1%对17.5%,p = 0.415)未记录到显著差异。IAHC组有1例患者术后死亡。非IAHC组术后住院时间显著更长(中位数:8天对10天,范围:6 - 13天对5 - 33天;p = 0.004)。IAHC不会对后续肝切除术的预后产生负面影响。