AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
Ann Surg. 2011 Jun;253(6):1069-79. doi: 10.1097/SLA.0b013e318217e898.
An expansion of resectability criteria of colorectal liver metastases (CLM) is justified provided "acceptable" short-term and long-term outcomes. The aim of the present study was to ascertain this paradigm in an era of modern liver surgery.
All consecutive patients who underwent hepatic resection for CLM at our institute between 1990 and 2010 were included in the study. Ninety-day mortality and morbidity rates were determined in the total study population and in 2 separate time periods (group I: 1990-2000; group II: 2000-2010). Similarly, overall and progression-free survival rates were determined. Independent predictors of postoperative morbidity were identified at multivariate analysis.
Between 1990 and 2010, 1394 hepatectomies were performed in 1028 patients. Overall perioperative mortality and postoperative morbidity rates were 1.3% and 33%, respectively. Although patients in group II were older, had more often comorbid illnesses, and presented with more extensive liver disease, similar perioperative mortality rates were observed (1.1% in group I and 1.4% in group II; P = 0.53). A trend toward a higher morbidity rate was observed in group II (34% vs 31% in group I; P = 0.16). Independent predictors of postoperative morbidity were: treatment between 2000 and 2010, total hepatic ischemia time of 60 minutes or more, maximum size of CLM of 30 mm or more at histopathology, and presence of abnormalities in the nontumoral liver parenchyma. Although a trend toward lower overall survival was observed in patients with significant postoperative complications, no significant differences were observed in long-term outcomes between both treatment periods.
After an aggressive multidisciplinary treatment of CLM, acceptable overall mortality and morbidity rates were observed. Perioperative mortality rates did not differ according to treatment period; however, more recently operated patients experienced more postoperative complications. These favorable short-term outcomes, without worsening of long-term outcomes, justify an expansion of the criteria for resectability in this patient category.
如果结直肠肝转移瘤（CLM）的可切除性标准能够获得“可接受”的短期和长期结果，那么扩大该标准是合理的。本研究的目的是在现代肝脏外科时代确定这一模式。
本研究纳入了 1990 年至 2010 年期间在我院行肝切除术治疗 CLM 的所有连续患者。在总研究人群和 2 个单独的时间段（第 I 组：1990-2000 年；第 II 组：2000-2010 年）中，确定了 90 天死亡率和发病率。同样，确定了总生存率和无进展生存率。多变量分析确定了术后发病率的独立预测因素。
1990 年至 2010 年间，对 1028 例患者中的 1394 例进行了肝切除术。围手术期总死亡率和术后发病率分别为 1.3%和 33%。尽管第 II 组的患者年龄较大，合并症较多，肝脏疾病更为广泛，但观察到的围手术期死亡率相似（第 I 组为 1.1%，第 II 组为 1.4%；P=0.53）。第 II 组的发病率呈上升趋势（34%比第 I 组的 31%；P=0.16）。术后发病率的独立预测因素为：2000 年至 2010 年期间的治疗、总肝缺血时间 60 分钟或以上、组织病理学上最大 CLM 直径 30 毫米或以上、非肿瘤性肝实质存在异常。尽管术后并发症显著的患者总生存率呈下降趋势，但在两个治疗期之间，长期结果没有显著差异。
在对结直肠肝转移瘤进行积极的多学科治疗后，观察到可接受的总死亡率和发病率。围手术期死亡率与治疗期无关；然而，最近接受手术的患者经历了更多的术后并发症。这些良好的短期结果，没有恶化长期结果，证明在该患者类别中扩大可切除性标准是合理的。
