Chun Yun Shin, Vauthey Jean-Nicolas, Ribero Dario, Donadon Matteo, Mullen John T, Eng Cathy, Madoff David C, Chang David Z, Ho Linus, Kopetz Scott, Wei Steven H, Curley Steven A, Abdalla Eddie K
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA.
J Gastrointest Surg. 2007 Nov;11(11):1498-504; discussion 1504-5. doi: 10.1007/s11605-007-0272-2. Epub 2007 Sep 11.
Two-stage hepatectomy has been proposed for patients with bilateral colorectal liver metastases (CLM). The aim of this study was to compare the outcome of patients with CLM treated with preoperative chemotherapy followed by one- or two-stage hepatectomy.
From a prospective database, 214 consecutive patients who received preoperative systemic chemotherapy (fluoropyrimidine with irinotecan or oxaliplatin) followed by planned one- or two-stage hepatectomy were retrospectively analyzed (1998-2006). In patients undergoing two-stage procedures, minor hepatectomy (wedge or segmental resection[s]) was systematically performed before major (more than three segments), second-stage hepatectomy. Preoperative portal vein embolization (PVE) was performed if indicated.
One- (group I) and two-stage (group II) hepatectomies were performed in 184 and 21 patients, respectively. Median number of metastases in groups I and II were two (range 1-20) and seven (range 2-20). All patients in group II had bilateral disease vs 39% in group I. Major hepatectomy was performed in all patients in group II and 79% in group I. PVE was performed in 18 group I and 12 group II patients without increase in morbidity. For group I, group II first stage, and group II second stage, respectively, morbidity (24%, 24%, 43%), median hospital stay (7 days, 6 days, 6.5 days) and 30 days postoperative mortality (2%, 0%, 0%) were not significantly different (P = NS). Median follow-up was 25 months; median survival has not been reached. One- and 3-year overall and disease-free survival rates from the time of hepatic resection were 95% and 75%, 63% and 39%, respectively in group I; 95% and 86%, 70% and 51%, respectively in group II (P = NS).
Two-stage hepatectomy with preoperative chemotherapy results in comparable morbidity and survival rates as one-stage hepatectomy. This approach enables selection and treatment of patients with multiple, bilateral CLM who will benefit from aggressive surgery with good outcomes.
对于双侧结直肠癌肝转移（CLM）患者，已提出采用两阶段肝切除术。本研究的目的是比较接受术前化疗后行一期或两阶段肝切除术的CLM患者的治疗结果。
从一个前瞻性数据库中，对214例连续接受术前全身化疗（氟嘧啶联合伊立替康或奥沙利铂）并计划行一期或两阶段肝切除术的患者进行回顾性分析（1998 - 2006年）。在接受两阶段手术的患者中，在主要的（超过三个肝段）二期肝切除术之前，系统地先进行小范围肝切除术（楔形或肝段切除术）。如有指征，则进行术前门静脉栓塞（PVE）。
分别对184例和21例患者进行了一期（I组）和两阶段（II组）肝切除术。I组和II组转移灶的中位数分别为2个（范围1 - 20个）和7个（范围2 - 20个）。II组所有患者均为双侧病变，而I组为39%。II组所有患者均进行了大范围肝切除术，I组为79%。18例I组患者和12例II组患者进行了PVE，且发病率未增加。I组、II组第一阶段和II组第二阶段的发病率分别为24%、24%、43%，中位住院时间分别为7天、6天、6.5天，术后30天死亡率分别为2%、0%、0%，差异均无统计学意义（P = 无显著性差异）。中位随访时间为25个月；中位生存期尚未达到。I组肝切除术后1年和3年的总生存率及无病生存率分别为9５%和75%、63%和39%；II组分别为95%和86%、70%和５1%（P = 无显著性差异）。
术前化疗的两阶段肝切除术与一期肝切除术的发病率和生存率相当。这种方法能够筛选和治疗那些将从积极手术中获益且预后良好多项、双侧CLM患者。
