Suppr超能文献

肝切除术联合围手术期化疗治疗结直肠癌肝转移:R1 切除的肿瘤学结果。

Liver resection for colorectal liver metastases with peri-operative chemotherapy: oncological results of R1 resections.

机构信息

Department of Digestive and Hepatobiliary Surgery, AP-HP, Henri Mondor University Hospital, Créteil, France.

出版信息

HPB (Oxford). 2013 May;15(5):359-64. doi: 10.1111/j.1477-2574.2012.00581.x. Epub 2012 Oct 22.

Abstract

BACKGROUND

Retrospective analysis of outcomes of R0 (negative margin) versus R1 (positive margin) liver resections for colorectal metastases (CLM) in the context of peri-operative chemotherapy.

METHODS

All CLM resections between 2000 and 2006 were reviewed. Exclusion criteria included: macroscopically incomplete (R2) resections, the use of local treatment modalities, the presence of extra-hepatic disease and no peri-operative chemotherapy. R0/R1 status was based on pathological examination.

RESULTS

Of 86 eligible patients, 63 (73%) had R0 and 23 (27%) had R1 resections. The two groups were comparable for the number, size of metastases and type of hepatectomy. The R1 group had more bilobar CLM (52% versus 24%, P = 0.018). The median follow-up was 3.1 years. Five-year overall and disease-free survival were 54% and 21% for the R0 group and 49% and 22% for the R1 group (P = 0.55 and P = 0.39, respectively). An intra-hepatic recurrence was more frequent in the R1 group (52% versus 27%, P = 0.02) and occurred more frequently at the surgical margin (22% versus 3%, P = 0.01).

DISCUSSION

R1 resections were associated with a higher risk of intra-hepatic and surgical margin recurrence but did not negatively impact survival suggesting that in the era of efficient chemotherapy, the risk of an R1 resection should not be considered as a contraindication to surgery.

摘要

背景

在围手术期化疗的背景下,对结直肠癌肝转移(CLM)行 R0(阴性切缘)与 R1(阳性切缘)肝切除术的结果进行回顾性分析。

方法

回顾分析了 2000 年至 2006 年间所有的 CLM 切除术。排除标准包括:肉眼下不完全切除(R2)、局部治疗方法的应用、肝外疾病的存在和无围手术期化疗。R0/R1 状态基于病理检查。

结果

86 例符合条件的患者中,63 例(73%)为 R0 切除,23 例(27%)为 R1 切除。两组患者的转移灶数量、大小和肝切除术类型相似。R1 组中双侧 CLM 更多(52%比 24%,P = 0.018)。中位随访时间为 3.1 年。R0 组的 5 年总生存率和无病生存率分别为 54%和 21%,R1 组分别为 49%和 22%(P = 0.55 和 P = 0.39)。R1 组肝内复发更常见(52%比 27%,P = 0.02),且更常发生于手术切缘(22%比 3%,P = 0.01)。

讨论

R1 切除术与肝内和手术切缘复发风险增加相关,但未对生存产生负面影响,这表明在化疗有效的时代,不应将 R1 切除术的风险视为手术的禁忌证。

相似文献

1
Liver resection for colorectal liver metastases with peri-operative chemotherapy: oncological results of R1 resections.
HPB (Oxford). 2013 May;15(5):359-64. doi: 10.1111/j.1477-2574.2012.00581.x. Epub 2012 Oct 22.
2
R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery?
Ann Surg. 2008 Oct;248(4):626-37. doi: 10.1097/SLA.0b013e31818a07f1.
5
R1 Resection for Colorectal Liver Metastases: a Survey Questioning Surgeons about Its Incidence, Clinical Impact, and Management.
J Gastrointest Surg. 2018 Oct;22(10):1752-1763. doi: 10.1007/s11605-018-3820-z. Epub 2018 Jun 8.
9
Outcome of microscopic incomplete resection (R1) of colorectal liver metastases in the era of neoadjuvant chemotherapy.
Ann Surg Oncol. 2012 May;19(5):1618-27. doi: 10.1245/s10434-011-2114-4. Epub 2011 Oct 18.

引用本文的文献

4
Optimizing the Personalized Care for the Management of Rectal Cancer: A Consensus Statement.
Turk J Gastroenterol. 2022 Aug;33(8):627-663. doi: 10.5152/tjg.2022.211103.
6
Reevaluating the Evidence for Intensive Postoperative Extracolonic Surveillance for Nonmetastatic Colorectal Cancer.
Value Health. 2022 Jan;25(1):36-46. doi: 10.1016/j.jval.2021.07.017. Epub 2021 Oct 13.
7
9
R1 Resection for Colorectal Liver Metastases: a Survey Questioning Surgeons about Its Incidence, Clinical Impact, and Management.
J Gastrointest Surg. 2018 Oct;22(10):1752-1763. doi: 10.1007/s11605-018-3820-z. Epub 2018 Jun 8.
10
The Prognostic Value of Varying Definitions of Positive Resection Margin in Patients with Colorectal Cancer Liver Metastases.
J Gastrointest Surg. 2018 Aug;22(8):1350-1357. doi: 10.1007/s11605-018-3748-3. Epub 2018 Apr 9.

本文引用的文献

4
Hepatic resection for colorectal metastases: the impact of surgical margin status on outcome.
HPB (Oxford). 2010 Feb;12(1):43-9. doi: 10.1111/j.1477-2574.2009.00121.x.
5
Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer.
N Engl J Med. 2009 Apr 2;360(14):1408-17. doi: 10.1056/NEJMoa0805019.
7
New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).
Eur J Cancer. 2009 Jan;45(2):228-47. doi: 10.1016/j.ejca.2008.10.026.
8
R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery?
Ann Surg. 2008 Oct;248(4):626-37. doi: 10.1097/SLA.0b013e31818a07f1.
9
Appraisal of 1 cm hepatectomy margins for intrahepatic micrometastases in patients with colorectal carcinoma liver metastasis.
Ann Surg Oncol. 2008 Sep;15(9):2472-81. doi: 10.1245/s10434-008-0023-y. Epub 2008 Jul 2.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验