Fukuoka Kengo, Nara Satoshi, Honma Yoshitaka, Kishi Yoji, Esaki Minoru, Shimada Kazuaki
Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan.
World J Surg. 2017 Apr;41(4):1073-1081. doi: 10.1007/s00268-016-3724-6.
Recently, an increasing number of patients with liver metastases from colorectal cancer have received chemotherapy before hepatectomy. However, the effect of chemotherapy on postoperative short-term outcome is not well defined.
We retrospectively investigated the postoperative complications of 439 patients who underwent hepatectomy for colorectal liver metastases in our division from 2005 to 2014. Patients were classified into two groups according to the presence (Cx; 84 patients) or absence (NCx; 355 patients) of preoperative chemotherapy. Univariate and multivariate analyses were conducted to determine the predictive factors for postoperative complications.
There was neither mortality nor liver failure after surgery. There was no significant difference in the frequency of postoperative complications between Groups Cx and NCx [29 vs 26 % for all complications; both 6 % for bile leakage that required therapeutic intervention; and 2 vs 3 % for Clavien-Dindo (CD) Grade ≥ IIIa, respectively]. In Group Cx, morbidity rates were similar among patients with different chemotherapy regimens. Chemotherapy-related factors (administration of bevacizumab, oxaliplatin or irinotecan, duration of chemotherapy >150 days, and timing of hepatectomy) were not significantly associated with clinically relevant bile leakage and CD ≥ IIIa in multivariate analysis.
Even after combination chemotherapy including targeted therapy, hepatectomy for colorectal liver metastases can be performed safely without increasing morbidity or mortality, if the patients fulfill the conventional criteria for surgery.
最近，越来越多的结直肠癌肝转移患者在肝切除术前接受了化疗。然而，化疗对术后短期结局的影响尚不明确。
我们回顾性调查了2005年至2014年在我科接受结直肠癌肝转移肝切除术的439例患者的术后并发症。根据术前是否接受化疗（Cx组；84例患者）将患者分为两组，未接受化疗组（NCx组；355例患者）。进行单因素和多因素分析以确定术后并发症的预测因素。
术后无死亡病例，也无肝衰竭发生。Cx组和NCx组术后并发症发生率无显著差异[所有并发症发生率分别为29%和26%；需要治疗干预的胆漏发生率均为6%；Clavien-Dindo（CD）分级≥Ⅲa级的发生率分别为2%和3%]。在Cx组中，不同化疗方案的患者发病率相似。在多因素分析中，化疗相关因素（贝伐单抗、奥沙利铂或伊立替康的使用、化疗持续时间>150天以及肝切除时间）与临床相关胆漏和CD≥Ⅲa级无显著相关性。
即使在包括靶向治疗的联合化疗后，如果患者符合传统手术标准，结直肠癌肝转移肝切除术也可安全进行，而不会增加发病率或死亡率。
