Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
J Surg Oncol. 2013 Dec;108(7):444-9. doi: 10.1002/jso.23429. Epub 2013 Sep 5.
To date, there is limited data on the liver-first approach in the management of colorectal liver metastases (CRLM). The aim of the study was to assess the outcomes of the liver-first approach for patients with synchronous CRLM in two tertiary referral centers.
Patients with stage IV colorectal cancer selected for the liver-first approach from January 2009 to December 2012 in two tertiary referral centers were included. Data collated included demographics, chemotherapy, operative findings, histo-pathological features, and survival.
Thirty-seven patients with synchronous CRLM were considered for the liver-first approach. Twenty-five patients had rectal cancer. All patients underwent induction chemotherapy. Thirty patients underwent hepatic resections with no post-operative deaths. Following liver resection, five patients failed to proceed to colorectal resection and one patient had complete response to chemo-radiotherapy. Of the 25 patients that completed the liver-first approach, 13 patients had recurrent disease, of which 12 patients died. The overall 1- and 3-year survival rates were 65.9% and 30.4%, respectively.
The liver-first approach is a feasible strategy for patients with synchronous CRLM and may improve survival in selected patients. The selection of patients should be incorporated in a multidisciplinary approach to achieve the best possible outcomes.
迄今为止，关于结直肠癌肝转移（CRLM）的肝优先治疗方法的数据有限。本研究的目的是评估在两个三级转诊中心对同步 CRLM 患者采用肝优先治疗方法的结果。
纳入了 2009 年 1 月至 2012 年 12 月期间在两个三级转诊中心选择肝优先治疗方法的 IV 期结直肠癌患者。收集的数据包括人口统计学、化疗、手术发现、组织病理学特征和生存情况。
37 例同步 CRLM 患者被认为适合肝优先治疗方法。25 例患者患有直肠癌。所有患者均接受了诱导化疗。30 例患者接受了肝切除术，无术后死亡。肝切除术后，5 例患者未能进行结直肠切除术，1 例患者对化疗和放疗完全有反应。在完成肝优先治疗方法的 25 例患者中，13 例患者出现复发性疾病，其中 12 例患者死亡。总体 1 年和 3 年生存率分别为 65.9%和 30.4%。
肝优先治疗方法是治疗同步 CRLM 患者的一种可行策略，可改善部分患者的生存情况。应将患者的选择纳入多学科方法，以获得最佳的治疗效果。
