Bova R, Kamphues C, Neuhaus P, Puhl G
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité, Campus Virchow Klinikum, Berlin, Deutschland.
Zentralbl Chir. 2014 Apr;139(2):220-5. doi: 10.1055/s-0032-1328568. Epub 2013 Jul 11.
Today, liver resection represents the only curative treatment option for patients with resectable colorectal liver metastases. Large studies could show that liver surgery can be performed safely in specialised centres, but most of those studies did not differentiate between resection of synchronous and metachronous metastases. The aim of this study was to evaluate the impact of the time of the occurrence of colorectal liver metastases on the early postoperative course as well as the long-term survival.
Two groups of 30 patients each who underwent liver surgery due to synchronous or metachronous colorectal liver metastases at our centre between 2000 and 2010 were included in a matched-pairs analysis. Early postoperative course as well as long-term survival were assessed and compared between both groups. Matching criteria included: age, sex, number of metastases and size of largest metastasis.
Postoperative morbidity for the entire study cohort was 23.3 % with a mortality of 0 %. No significant difference could be shown between synchronous and metachronous metastases with regard to incidence and severity of postoperative complications (20 vs. 26.7 %, p = 0.54). The median survival of the synchronous group was 38.9 months (95 % CI 26.4-51.6) compared to 47.9 months (95 % CI 21.4-74.4 %) in the metachronous group, but no significant difference could be detected in the univariate analysis (p = 0.425).
According to the present results, liver surgery can be performed safely in a specialised centre. The time of occurrence of the metastases (synchronous vs. metachronous) does not seem to have any impact on the early postoperative course as well as on the long-term survival in patients undergoing curative resection of colorectal liver metastases. However, larger studies appear necessary to confirm the results of the present study.
如今，肝切除术是可切除的结直肠癌肝转移患者唯一的治愈性治疗选择。大型研究表明，在专业中心可以安全地进行肝脏手术，但大多数此类研究并未区分同期和异时转移瘤的切除情况。本研究的目的是评估结直肠癌肝转移发生时间对术后早期病程以及长期生存的影响。
对2000年至2010年间在我们中心因同期或异时性结直肠癌肝转移而接受肝脏手术的两组患者（每组30例）进行配对分析。评估并比较两组患者术后的早期病程以及长期生存情况。配对标准包括：年龄、性别、转移瘤数量和最大转移瘤的大小。
整个研究队列的术后发病率为23.3%，死亡率为0%。同期和异时转移瘤在术后并发症的发生率和严重程度方面无显著差异（20%对26.7%，p = 0.54）。同期组的中位生存期为38.9个月（95%CI 26.4 - 51.6），而异时组为47.9个月（95%CI 21.4 - 74.4%），但单因素分析未发现显著差异（p = 0.425）。
根据目前的结果，在专业中心可以安全地进行肝脏手术。转移瘤的发生时间（同期与异时）似乎对接受结直肠癌肝转移根治性切除的患者术后早期病程以及长期生存没有任何影响。然而，似乎需要更大规模的研究来证实本研究的结果。
