Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
JAMA Surg. 2013 Jul;148(7):597-601. doi: 10.1001/jamasurg.2013.1431.
Ablative therapies extend the capability of delivering potentially curative treatment for bilateral hepatic colorectal metastases.
To compare the long-term effectiveness of ablation with that of resection in patients with bilateral hepatic colorectal metastases.
Review of a prospective database of 2123 operative cases of hepatic colorectal metastases.
A large institution with expertise in ablation and resection.
Patients with bilateral colorectal liver metastases undergoing operation with a curative intent. A total of 141 patients had been treated with bilateral resection (BR) and 95 had undergone ablation.
Radiofrequency or microwave ablation alone or in combination with resection (A/R) compared with BR.
We compared tumor characteristics and operative and postoperative outcomes using χ2 or Wilcoxon tests as appropriate and assessed overall survival differences between the 2 groups using the log-rank test.
During the study, 141 patients were treated with BR and 95 patients with A/R. The A/R group was a significantly poorer prognostic group than the BR group as judged by the Clinical Risk Score (P < .01). There was no difference in median operative time (A/R: 280 minutes, BR: 282 minutes; P = .52), but a lower blood loss (A/R: 300 mL, BR: 500 mL; P < .01) and a shorter length of stay (A/R: 7 days, BR: 9 days; P < .01) was achieved in the A/R group. Long-term outcome was not significantly different between the groups (5-year overall survival, A/R: 56%, BR: 49%; P = .16).
Treatment of bilateral, multiple hepatic metastases with combined resection and ablation was associated with improved perioperative outcomes without compromising long-term survival compared with bilateral resection. Ablative therapies extend the capability of delivering potentially curative treatment for bilateral hepatic colorectal metastases.
消融疗法扩展了为双侧结直肠肝转移提供潜在治愈性治疗的能力。
比较消融与切除术治疗双侧结直肠肝转移患者的长期疗效。
回顾性分析 2123 例结直肠肝转移手术的前瞻性数据库。
具有消融和切除术专业知识的大型机构。
接受根治性手术治疗双侧结直肠肝转移的患者。共有 141 例患者接受双侧切除术（BR）治疗，95 例患者接受消融治疗。
单独或联合切除的射频或微波消融（A/R）与 BR 相比。
我们使用 χ2 或 Wilcoxon 检验比较肿瘤特征和手术及术后结果，并使用对数秩检验评估两组之间的总生存差异。
在研究期间，141 例患者接受 BR 治疗，95 例患者接受 A/R 治疗。根据临床风险评分（P <.01），A/R 组是预后较差的组。两组的中位手术时间无差异（A/R：280 分钟，BR：282 分钟；P =.52），但 A/R 组出血量较少（A/R：300 毫升，BR：500 毫升；P <.01），住院时间较短（A/R：7 天，BR：9 天；P <.01）。两组的长期结果无显著差异（5 年总生存率，A/R：56%，BR：49%；P =.16）。
与双侧切除术相比，联合切除和消融治疗双侧、多发性肝转移可改善围手术期结果，而不影响长期生存。消融疗法扩展了为双侧结直肠肝转移提供潜在治愈性治疗的能力。
