Tanaka K, Adam R, Shimada H, Azoulay D, Lévi F, Bismuth H
Department of Surgery II, Yokohama City University School of Medicine, Yokohama, Japan.
Br J Surg. 2003 Aug;90(8):963-9. doi: 10.1002/bjs.4160.
The role of neoadjuvant chemotherapy for patients with multiple (five or more) bilobar hepatic metastases irrespective of initial resectability is still under scrutiny. The purpose of this study was to compare the outcome of hepatectomy alone with that of hepatectomy after neoadjuvant chemotherapy for multiple bilobar hepatic metastases from colorectal cancer.
Retrospective data were collected from 71 patients after hepatectomy for five or more bilobar liver tumours. The outcome of 48 patients treated by neoadjuvant chemotherapy followed by hepatectomy was compared with that of 23 patients treated by hepatectomy alone.
Patients who received neoadjuvant chemotherapy had better 3- and 5-year survival rates from the time of diagnosis than those who did not (67.0 and 38.9 versus 51.8 and 20.7 per cent respectively; P = 0.039), and required fewer extended hepatectomies (four segments or more) (39 of 48 versus 23 of 23; P = 0.027). Multivariate analysis showed neoadjuvant chemotherapy to be an independent predictor of survival.
In patients with bilateral multiple colorectal liver metastases, neoadjuvant chemotherapy before hepatectomy was associated with improved survival and enabled complete resection with fewer extended hepatectomies.
新辅助化疗对于患有多发（五个或更多）双侧肝转移的患者（无论初始是否可切除）的作用仍在研究中。本研究的目的是比较单纯肝切除术与新辅助化疗后肝切除术治疗结直肠癌双侧多发肝转移的疗效。
收集了71例因五个或更多双侧肝肿瘤接受肝切除术后患者的回顾性数据。将48例接受新辅助化疗后行肝切除术的患者的疗效与23例单纯行肝切除术的患者的疗效进行比较。
接受新辅助化疗的患者从诊断时起的3年和5年生存率高于未接受新辅助化疗的患者（分别为67.0%和38.9%，对比51.8%和20.7%；P = 0.039），并且需要进行扩大肝切除术（四个或更多肝段）的患者更少（48例中的39例对比23例中的23例；P = 0.027）。多因素分析显示新辅助化疗是生存的独立预测因素。
在双侧多发结直肠癌肝转移患者中，肝切除术前进行新辅助化疗与生存率提高相关，并且能够以较少的扩大肝切除术实现完整切除。
