Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2013 Aug;20(8):2477-84. doi: 10.1245/s10434-013-2975-9. Epub 2013 Apr 23.
Perioperative outcomes, such as blood loss, transfusions, and morbidity, have been linked to cancer-specific survival, but this is largely unsupported by prospective data.
Patients from a previous, randomized trial that evaluated acute normovolemic hemodilution during major hepatectomy (≥3 segments) were reevaluated and those with metastatic colorectal cancer (n = 90) were selected for analysis. Survival data were obtained from the medical record. Disease extent was measured using a clinical-risk score (CRS). Log-rank test and Cox proportional hazard model were used to evaluate recurrence-free survival (RFS) and overall survival (OS).
Median follow-up was 71 months. The CRS was ≥3 in 45 % of patients; 59 % had extrahepatic procedures. Morbidity and mortality were 33 and 2 %, respectively. Postoperative chemotherapy was given to 87 % of patients (78/90) starting at a median of 6 weeks. RFS and OS were 29 and 60 months, respectively. Postoperative morbidity significantly reduced RFS (23 vs. 69 months; P < 0.001) and OS (28 vs. 74 months; P < 0.001) on uni- and multi-variate analysis; positive resection margins and high CRS also were significant factors. Delayed initiation of postoperative chemotherapy (≥8 weeks) was common in patients with complications (37 vs. 12 %; P = 0.01).
In this selected cohort of patients from a previous RCT, perioperative morbidity was strongly (and independently) associated with cancer-specific outcome. It also was associated with delayed initiation of postoperative chemotherapy, the impact of which on survival is unclear.
围手术期结局，如出血量、输血和发病率，与癌症特异性生存相关，但这在很大程度上没有前瞻性数据支持。
对先前评估在重大肝切除术中（≥3 个节段）进行急性等容血液稀释的随机试验中的患者进行重新评估，并选择转移性结直肠癌（n=90）患者进行分析。生存数据来自病历。疾病程度使用临床风险评分（CRS）进行测量。使用对数秩检验和 Cox 比例风险模型评估无复发生存（RFS）和总生存（OS）。
中位随访时间为 71 个月。CRS≥3 的患者占 45%；59%的患者进行了肝外手术。发病率和死亡率分别为 33%和 2%。术后化疗于 90 例患者中的 87%（78/90）开始，中位数为 6 周。RFS 和 OS 分别为 29 和 60 个月。术后发病率显著降低 RFS（23 与 69 个月；P<0.001）和 OS（28 与 74 个月；P<0.001），单因素和多因素分析均如此；阳性切缘和高 CRS 也是重要因素。术后并发症患者中（37%与 12%；P=0.01），术后化疗开始延迟（≥8 周）很常见。
在这项来自先前 RCT 的患者的选择队列中，围手术期发病率与癌症特异性结局密切相关（且独立相关）。它还与术后化疗开始延迟相关，其对生存的影响尚不清楚。
