Kulaylat Afif N, Bhayani Neil H, Stokes Audrey L, Schubart Jane R, Wong Joyce, Kimchi Eric T, Staveley-O'Carroll Kevin F, Kaifi Jussuf T, Gusani Niraj J
Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, 17033-0850, USA.
J Gastrointest Surg. 2014 Nov;18(11):1894-901. doi: 10.1007/s11605-014-2580-7. Epub 2014 Jun 21.
Following curative intent surgery (CIS) for colorectal liver metastasis (CRLM), repeat CIS for recurrence improves survival. The factors associated with repeat CIS are not widely reported.
An institutional database (January 2002-December 2012) was reviewed to evaluate factors influencing repeat CIS.
One hundred sixty-three patients with colorectal liver metastasis (CRLM) underwent successful CIS. Median follow-up and disease-free interval (DFI) was 33 and 16 months, respectively. After initial CIS, 102 patients (63%) recurred. Fifty-three patients (52%) underwent a repeat CIS. After repeat CIS, 33 patients (62%) developed a second recurrence, and in 13 patients (39%), a third CIS was possible. DFI decreased following initial CIS (first CIS vs. second CIS vs. third CIS [20 vs. 15 vs. 8.5 months], p < 0.001). Overall 5-year survival in all patients was 55%; patients who recurred had a 5-year survival of 67% if they underwent repeat CIS vs. 7.8% if they were managed palliatively. Second CIS was less likely with a postoperative complication, other/multifocal recurrence, or DFI <12 months.
Despite high recurrence and decreasing DFI, repeat CIS provides a survival benefit. Postoperative complications, DFI, number, and pattern of recurrence influence the decision to pursue repeat CIS.
对于结直肠癌肝转移（CRLM）患者，在进行根治性意向手术（CIS）后，针对复发情况再次进行CIS可提高生存率。与再次进行CIS相关的因素尚无广泛报道。
回顾一个机构数据库（2002年1月至2012年12月），以评估影响再次进行CIS的因素。
163例结直肠癌肝转移患者成功接受了CIS。中位随访时间和无病间期（DFI）分别为33个月和16个月。首次CIS后，102例患者（63%）复发。53例患者（52%）接受了再次CIS。再次CIS后，33例患者（62%）出现第二次复发，13例患者（39%）有可能进行第三次CIS。首次CIS后DFI缩短（首次CIS vs. 第二次CIS vs. 第三次CIS [20 vs. 15 vs. 8.5个月]，p < 0.001）。所有患者的总体5年生存率为55%；复发患者若接受再次CIS，其5年生存率为67%，而姑息治疗患者的5年生存率为7.8%。出现术后并发症、其他/多灶性复发或DFI<12个月时，再次进行CIS的可能性较小。
尽管复发率高且DFI缩短，但再次进行CIS仍能带来生存获益。术后并发症、DFI、复发次数和复发模式会影响是否进行再次CIS的决策。
