Chok Kenneth S H, Cheung Tan To, Chan Albert C Y, Dai Wing Chiu, Chan See Ching, Fan Sheung Tat, Poon Ronnie T P, Lo Chung Mau
Department of Surgery, The University of Hong Kong, Hong Kong, China.
ANZ J Surg. 2014 Jul-Aug;84(7-8):545-9. doi: 10.1111/ans.12298. Epub 2013 Jun 30.
This study aimed to investigate whether re-resection can achieve a good survival outcome in the treatment of recurrent liver metastases of colorectal cancer.
Prospectively collected data of patients who underwent hepatectomy for liver tumours were reviewed. Patients whose liver tumours were metastases of colorectal cancer were included in the study provided that they had no extrahepatic metastases and received no loco-ablative treatment simultaneous with hepatectomy. Patients who did not have recurrent liver metastasis after their first liver resection (group R) and patients who underwent re-resection for recurrent liver metastasis (group RR) were compared.
In total, 321 patients were included in the study, with 307 in group R and 14 in group RR. The two groups had comparable demographics. Insignificantly more patients in group R received major resection (55.6% versus 30.8%, P = 0.079). The median blood loss volume was 0.6 (0-12.7) L in group R and 0.35 (0-15) L in group RR (P = 0.202). Group RR had a significantly smaller median tumour size (2.5 cm versus 3.5 cm, P = 0.020) and resection margin width (0.3 cm versus 0.7 cm, P = 0.037). On univariate analysis, re-resection was not a risk factor in overall survival. On multivariate analysis, post-operative complication (hazard ratio (HR) 1.66, 95% confidence interval (CI) 1.15-2.39, P = 0.007), microscopic margin involvement (HR 1.95, 95% CI 1.26-3.04, P = 0.003) and multiple tumours (HR 1.58, 95% CI 1.17-2.14, P = 0.003) were risk factors in overall survival. The two groups had no significant differences in disease-free survival and overall survival.
Re-resection for recurrent colorectal liver metastases can achieve a favourable survival outcome at centres with expertise.
本研究旨在探讨再次手术切除在结直肠癌复发性肝转移治疗中能否取得良好的生存结局。
回顾前瞻性收集的接受肝肿瘤肝切除术患者的数据。肝肿瘤为结直肠癌转移灶的患者，若没有肝外转移且在肝切除时未同时接受局部消融治疗，则纳入本研究。比较首次肝切除后未发生复发性肝转移的患者（R组）和因复发性肝转移接受再次手术切除的患者（RR组）。
本研究共纳入321例患者，其中R组307例，RR组14例。两组患者的人口统计学特征具有可比性。R组接受大手术切除的患者略多（55.6% 对30.8%，P = 0.079）。R组术中中位失血量为0.6（0 - 12.7）L，RR组为0.35（0 - 15）L（P = 0.202）。RR组肿瘤中位大小（2.5 cm对3.5 cm，P = 0.020）和切缘宽度（0.3 cm对0.7 cm，P = 0.037）明显更小。单因素分析显示，再次手术切除不是总生存的危险因素。多因素分析显示，术后并发症（风险比（HR）1.66，95%置信区间（CI）1.15 - 2.39，P = 0.007）、显微镜下切缘受累（HR 1.95，95% CI 1.26 - 3.04，P = 0.003）和多发肿瘤（HR 1.58，95% CI 1.17 - 2.14，P = 0.003）是总生存的危险因素。两组患者的无病生存期和总生存期无显著差异。
在具备专业技术的中心，对复发性结直肠癌肝转移进行再次手术切除可取得良好的生存结局。
