Division of Surgical Oncology, Oregon Health and Science University, Portland, OR, USA,
J Gastrointest Surg. 2013 Dec;17(12):2133-42. doi: 10.1007/s11605-013-2295-1. Epub 2013 Oct 4.
Preoperative chemotherapy is increasingly utilized in the treatment of colorectal liver metastases (CRLM). Although this strategy may improve resectability, long-term advantages of preoperative chemotherapy for resectable CRLM are less clear. The objective of this study is to report safety and outcomes when perioperative chemotherapy is routinely added to surgery for CRLM.
A retrospective review of patients undergoing liver resections for CRLM during 2003-2011 in single academic oncology center. Demographic data, tumor characteristics, chemotherapy, surgical details, complications and survival were analyzed.
The study included 157 patients that underwent 168 liver operations. One hundred eighteen patients (70 %) underwent preoperative chemotherapy (75 % oxaliplatin-based). Preoperative portal vein embolization was utilized in 16 (10.1 %) patients. Overall survival (OS) was 89, 57, and 27 % at 1, 3, and 5 years, respectively (median survival-42.8 months). Eleven (7 %) patients had repeat resections for liver recurrence. Thirty-day mortality was 1.26 %, morbidity-24 % (6 %-liver related). Complications were not significantly different in patients that had preoperative chemotherapy. On a multivariate analysis advanced age and >3 lesions predicted poor OS, while advanced age, lesions >5 cm, synchronous lesions, margin-positivity and resection less than hepatectomy were associated with decreased DFS.
Our results suggest that even with chemotherapy and resection only a subset of patients remain disease-free after 5 years. However, even in a high-risk patient with multiple lesions, preoperative chemotherapy can be administered safely without apparent increase in postoperative complications. Perioperative chemotherapy should be considered particularly in patients with multifocal or large lesions, synchronous disease and short disease-free interval.
术前化疗越来越多地用于结直肠癌肝转移（CRLM）的治疗。虽然这种策略可能提高可切除性，但术前化疗对可切除 CRLM 的长期优势尚不清楚。本研究旨在报告在结直肠癌肝转移患者中常规添加围手术期化疗的安全性和结果。
对 2003 年至 2011 年间在单一学术肿瘤中心接受肝切除术治疗 CRLM 的患者进行回顾性分析。分析人口统计学数据、肿瘤特征、化疗、手术细节、并发症和生存情况。
研究纳入了 157 例接受 168 次肝手术的患者。118 例（70%）患者接受了术前化疗（75%基于奥沙利铂）。16 例（10.1%）患者接受了术前门静脉栓塞术。1 年、3 年和 5 年的总生存率（OS）分别为 89%、57%和 27%（中位生存时间为 42.8 个月）。11 例（7%）患者因肝复发行再次切除术。30 天死亡率为 1.26%，发病率为 24%（6%与肝脏相关）。接受术前化疗的患者并发症无显著差异。多因素分析显示，高龄和>3 个病灶预测 OS 不良，而高龄、病灶>5cm、同步病灶、切缘阳性和肝切除不足与 DFS 降低相关。
我们的结果表明，即使接受化疗和切除术，仍有一部分患者在 5 年后仍无疾病。然而，即使在存在多个病灶的高危患者中，术前化疗也可以安全地给予，而不会明显增加术后并发症。围手术期化疗应特别考虑多灶性或大病灶、同步疾病和较短无病间隔的患者。
