Capussotti L, Muratore A, Mulas M M, Massucco P, Aglietta M
Division of Surgical Oncology, Istituto per la Ricerca e la Cura del Cancro, Candiolo, Italy.
Br J Surg. 2006 Aug;93(8):1001-6. doi: 10.1002/bjs.5386.
Hepatic surgery is the treatment of choice for resectable colorectal liver metastases. Neoadjuvant chemotherapy can downstage the tumour and enable surgery in up to 38 per cent of patients whose tumours were initially considered irresectable.
This prospective study included 150 patients who underwent hepatic resection over a 4-year period. One hundred and sixteen patients had resection without neoadjuvant chemotherapy (group 1) and 34 had chemotherapy before liver surgery (group 2). Perioperative features, survival and pattern of recurrence were compared.
Median follow-up was 35.1 months. The in-hospital mortality rate was zero. Three-year overall survival in the two groups was comparable (P = 0.232). The 3-year disease-free survival rate was 21 per cent in the neoadjuvant group compared with 50.5 per cent in the immediate resection group (P < 0.001). Recurrence rates were 94 per cent (32 of 34) in group 1 and 66.4 per cent in group 2 (P = 0.001); extrahepatic recurrence, alone or associated with recurrence in the liver, was significantly more common in group 2 than in group 1 (78 versus 55 per cent; P = 0.016). Multivariate analysis revealed that resection of the recurrence was the most important independent prognostic factor for improved disease-free survival (relative risk 0.2; P < 0.001). Patients in group 2 had reduced disease-free survival (RR 1.8; P = 0.012).
The recurrence rate among patients who had neoadjuvant chemotherapy and surgery for initially irresectable liver metastases was extremely high. Re-resection should be attempted whenever feasible.
肝切除术是可切除的结直肠癌肝转移的首选治疗方法。新辅助化疗可使肿瘤降期，并使高达38%最初被认为不可切除的患者能够接受手术。
这项前瞻性研究纳入了150例在4年期间接受肝切除术的患者。116例患者未接受新辅助化疗即进行了切除（第1组），34例患者在肝脏手术前接受了化疗（第2组）。比较了围手术期特征、生存率和复发模式。
中位随访时间为35.1个月。住院死亡率为零。两组的3年总生存率相当（P = 0.232）。新辅助化疗组的3年无病生存率为21%，而直接切除组为50.5%（P < 0.001）。第1组的复发率为94%（34例中的32例），第2组为66.4%（P = 0.001）；第2组肝外复发单独或与肝内复发相关的情况明显比第1组更常见（78%对55%；P = 0.016）。多变量分析显示，复发灶的切除是改善无病生存的最重要独立预后因素（相对风险0.2；P < 0.001）。第2组患者的无病生存期缩短（风险比1.8；P = 0.012）。
对最初不可切除的肝转移灶进行新辅助化疗和手术的患者复发率极高。只要可行，应尝试再次切除。
