结直肠肝转移：肝门阻断在肝切除术中可降低部分患者肿瘤复发率。病例匹配分析。

Colorectal liver metastases: hepatic pedicle clamping during hepatectomy reduces the incidence of tumor recurrence in selected patients. Case-matched analysis.

机构信息

Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.

出版信息

Eur J Surg Oncol. 2013 Jul;39(7):726-33. doi: 10.1016/j.ejso.2013.03.015. Epub 2013 Apr 18.

DOI:10.1016/j.ejso.2013.03.015

PMID:23601983

Abstract

BACKGROUND

Hepatic pedicle clamping (HPC) during Liver Resection (LR) is a vascular procedure designed to prevent bleeding from the liver during hepatectomy. Outgrowth of pre-existing colorectal micrometastases may occur 5-6 times faster in occluded liver lobes than in non-occluded lobes. We conducted a case-matched analysis at our Institution to assess the effects of HPC on overall and recurrence-free survival in highly selected patients, who underwent LR due to Colorectal liver metastases (CLM).

MATERIALS AND METHODS

From January 2002 to December 2010, 120 patients operated for CLM were included into this case-matched study. Patients were allocated to two groups: Group-A patients who underwent HPC during LR; Group-B patients who underwent LR without HPC.

RESULTS

HPC during liver resection was associated with better overall patient 5-year survival (47.2% in Group-A and 32.1% in Group-B) (P-value = 0.06), and significantly better 5-year recurrence-free survival (49.9% in Group-A vs 18.3% in Group-B) (P-value = 0.010) The Cox regression model identified the following risk factors for worse prognosis in terms of shorter recurrence-free survival and higher incidence of tumor recurrence: no HPC (Group-B) (P-value = 0.032) and positive lymph nodes at the time of LR (P-value = 0.018).

CONCLUSION

Lack of HPC in selected patients who underwent LR for CLM results to be a strong independent risk factor for higher patient exposure to tumor recurrence. We suggest that hepatic hilum clamping should be seriously taken into consideration in this patient setting.

MINI-ABSTRACT: A case-matched study was performed in 120 patients undergoing liver resection due to colorectal liver metastases, comparing patients who received intermittent hepatic pedicle clamping (HPC) with those who did not. The 5-year overall survival rate was similar, but the 5-year recurrence-free rate was significantly higher with no HPC (p = 0.012).

摘要

背景

肝脏蒂夹闭（HPC）在肝切除术中是一种血管操作，旨在防止肝切除术中肝脏出血。在闭塞的肝叶中，预先存在的结直肠微转移的生长速度可能比非闭塞的肝叶快 5-6 倍。我们在本机构进行了一项病例匹配分析，以评估在高度选择的因结直肠肝转移（CLM）而行肝切除术的患者中，HPC 对总生存率和无复发生存率的影响。

材料和方法

从 2002 年 1 月至 2010 年 12 月，共有 120 例因 CLM 接受手术的患者纳入本病例匹配研究。患者分为两组：A 组患者在肝切除术中行 HPC；B 组患者在肝切除术中不行 HPC。

结果

肝切除术中行 HPC 与更好的患者 5 年总生存率相关（A 组为 47.2%，B 组为 32.1%）（P 值=0.06），并显著改善了 5 年无复发生存率（A 组为 49.9%，B 组为 18.3%）（P 值=0.010）。Cox 回归模型确定了以下与无复发生存率较短和肿瘤复发率较高相关的预后不良的风险因素：无 HPC（B 组）（P 值=0.032）和 LR 时存在阳性淋巴结（P 值=0.018）。