Okuno Masayuki, Hatano Etsuro, Kasai Yosuke, Nishio Takahiro, Seo Satoru, Taura Kojiro, Yasuchika Kentaro, Nitta Takashi, Mori Akira, Okajima Hideaki, Kaido Toshimi, Hasegawa Suguru, Matsumoto Shigemi, Sakai Yoshiharu, Uemoto Shinji
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Clinical Oncology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Surg Today. 2016 Jun;46(6):721-8. doi: 10.1007/s00595-015-1242-z. Epub 2015 Aug 28.
To investigate the outcomes of patients with colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated using the liver-first approach in the era of modern chemotherapy in Japan.
We analyzed and compared data retrospectively on patients with asymptomatic resectable colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated either using the liver-first approach (n = 12, LF group) or the primary-first approach (n = 13, PF group).
Both groups of patients completed their therapeutic plan and there was no mortality. Postoperative morbidity rates after primary resection and hepatectomy, and post-hepatectomy liver failure rate were comparable between the groups (p = 1.00, p = 0.91, and p = 0.55, respectively). Recurrence rates, median recurrence-free survival since the last operation, and 3-year overall survival rates from diagnosis were also comparable between the LF and PF groups (58.3 vs. 61.5 %, p = 0.87; 10.5 vs. 18.6 months, p = 0.57; and 87.5 vs. 82.5 %, p = 0.46, respectively).
The liver-first approach may be an appropriate treatment sequence without adversely affecting perioperative or survival outcomes for selected patients.
研究在日本现代化疗时代采用肝优先方法治疗的结直肠癌合并初始不可切除或非最佳可切除肝转移患者的治疗结果。
我们回顾性分析并比较了无症状可切除结直肠癌合并初始不可切除或非最佳可切除肝转移患者的数据，这些患者采用肝优先方法（n = 12，LF组）或原发灶优先方法（n = 13，PF组）进行治疗。
两组患者均完成了治疗计划，且无死亡病例。两组患者在初次切除和肝切除术后的术后发病率以及肝切除术后肝衰竭发生率相当（分别为p = 1.00、p = 0.91和p = 0.55）。LF组和PF组之间的复发率、自上次手术以来的中位无复发生存期以及诊断后的3年总生存率也相当（分别为58.3%对61.5%，p = 0.87；10.5个月对18.6个月，p = 0.57；87.5%对82.5%，p = 0.46）。
对于部分患者，肝优先方法可能是一种合适的治疗顺序，不会对围手术期或生存结果产生不利影响。
