Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
World J Surg. 2012 Aug;36(8):1832-41. doi: 10.1007/s00268-012-1578-0.
Tumor downsizing by effective chemotherapy while increasing remnant liver volume by two-stage hepatectomy can expand eligibility for resection of otherwise unresectable liver metastases. However, optimal timing of two-stage hepatectomy with respect to chemotherapy is undetermined.
We retrospectively analyzed the effect of timing of two-stage hepatectomy and chemotherapy using data from 95 patients whose colorectal liver metastases initially were considered unresectable.
In 21 of 22 (95 %) patients whose first liver resection preceded chemotherapy (Hx-CTx group) and in 39 of 73 (53 %) patients whose chemotherapy preceded surgery (CTx-Hx group), macroscopic complete resection ultimately was achieved (P < 0.01). Overall and disease-free survivals were comparable between groups. However, overall survival of patients not achieving complete resection in the CTx-Hx group was significantly poorer than that for patients achieving complete resection (P < 0.01). When the 21 patients with complete resection in the Hx-CTx group were compared to the 39 patients with complete resection in the CTx-Hx group, no difference in overall or disease-free survival was observed (P = 0.12 and P = 0.24, respectively), although poor response to chemotherapy was more frequent in the Hx-CTx group.
Optimal timing of hepatectomy and chemotherapy is difficult to specify, but performing the initial resection in a two-stage hepatectomy before chemotherapy may increase likelihood of macroscopic complete resection, even in patients with a poor response to chemotherapy or with limited courses of chemotherapy.
通过有效的化疗使肿瘤缩小，并通过两阶段肝切除术增加残余肝体积，可以扩大对原本不可切除的肝转移灶进行切除的适应证。然而，化疗与两阶段肝切除术的最佳时机尚未确定。
我们回顾性分析了 95 例最初被认为无法切除的结直肠癌肝转移患者的数据，以评估两阶段肝切除术和化疗的时机对治疗效果的影响。
在 22 例（95%）先进行肝切除后化疗（Hx-CTx 组）的患者中，以及在 73 例（53%）先化疗后手术（CTx-Hx 组）的患者中，最终实现了肉眼完全切除（P<0.01）。两组的总生存率和无病生存率相当。然而，CTx-Hx 组未达到完全切除的患者的总生存率明显低于达到完全切除的患者（P<0.01）。将 Hx-CTx 组中 21 例完全切除的患者与 CTx-Hx 组中 39 例完全切除的患者进行比较，未观察到总生存率和无病生存率的差异（P=0.12 和 P=0.24，分别），尽管 Hx-CTx 组中对化疗的反应较差更为常见。
肝切除术和化疗的最佳时机难以确定，但在化疗前进行两阶段肝切除的初始切除可能会增加肉眼完全切除的可能性，即使在对化疗反应不佳或化疗疗程有限的患者中也是如此。
