Tanaka Kuniya, Murakami Takashi, Matsuo Kenichi, Hiroshima Yukihiko, Endo Itaru, Ichikawa Yasushi, Taguri Masataka, Koda Keiji
Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
Dig Surg. 2015;32(1):16-22. doi: 10.1159/000370253. Epub 2015 Jan 22.
Although a 'liver-first' approach recently has been advocated in treating synchronous colorectal metastases, little is known about how results compare with those of the classical approach among patients with similar grades of liver metastases.
Propensity-score matching was used to select study subjects. Oncologic outcomes were compared between 10 consecutive patients with unresectable advanced and aggressive synchronous colorectal liver metastases treated with the reverse strategy and 30 comparable classically treated patients.
Numbers of recurrence sites and recurrent tumors irrespective of recurrence sites were greater in the reverse group then the classic group (p = 0.003 and p = 0.015, respectively). Rates of freedom from recurrence in the remaining liver and of freedom from disease also were poorer in the reverse group than in the classical group (p = 0.009 and p = 0.043, respectively). Among patients treated with 2-stage hepatectomy, frequency of microvascular invasion surrounding macroscopic metastases at second resection was higher in the reverse group than in the classical group (p = 0.011).
Reverse approaches may be feasible in treating synchronous liver metastases, but that strategy should be limited to patients with less liver tumor burden.
尽管最近有人主张采用“肝优先”方法治疗同时性结直肠癌肝转移，但对于肝转移分级相似的患者，该方法与传统方法的治疗结果相比了解甚少。
采用倾向评分匹配法选择研究对象。对10例采用逆向策略治疗的不可切除的晚期侵袭性同时性结直肠癌肝转移患者和30例采用传统方法治疗的可比患者的肿瘤学结局进行比较。
逆向组的复发部位数量和无论复发部位的复发性肿瘤数量均多于传统组（分别为p = 0.003和p = 0.015）。逆向组剩余肝脏的无复发生存率和无病生存率也低于传统组（分别为p = 0.009和p = 0.043）。在接受二期肝切除术的患者中，逆向组二次切除时肉眼可见转移灶周围微血管侵犯的频率高于传统组（p = 0.011）。
逆向方法在治疗同时性肝转移中可能可行，但该策略应限于肝肿瘤负荷较小的患者。
