Nanji Sulaiman, Tsang Melanie E, Wei Xuejiao, Booth Christopher M
Department of Surgery, Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada.
Department of Surgery, Grand River Hospital, Kitchener, Ontario, Canada.
Am J Surg. 2017 Jun;213(6):1053-1059. doi: 10.1016/j.amjsurg.2016.08.014. Epub 2016 Sep 6.
More than half of the patients undergoing resection for colorectal cancer liver metastases develop recurrent hepatic disease. We report management and outcomes of patients undergoing repeat hepatectomy in routine practice.
All cases of repeat hepatectomy for colorectal cancer liver metastases from 2002 to 2009 in the Canadian Province of Ontario were identified using the population-based Ontario Cancer Registry and linked treatment records.
Of 1,310 patients who underwent resection of CRLM, 78 (6.0%) underwent a repeat liver resection. Mean age was 56 years and the median time between resections was 19 months. Compared with the first resection, second resections were associated with fewer lesions (2.7 vs 1.5; P = .001) and fewer major resections (58% vs 31%; P = .024). The size of largest lesion, positive margin rate, length of hospital stay, and 90-day mortality were similar. Unadjusted 5-year overall survival from the time of second resection was 45% (95% confidence interval = 32% to 59%) and cancer-specific survival was 47% (95% confidence interval = 30% to 64%).
Repeat liver resections for metastatic CRC involve fewer lesions and less extensive surgery and a substantial proportion of patients achieve long-term survival.
接受结直肠癌肝转移灶切除手术的患者中，超过半数会出现肝脏疾病复发。我们报告了在常规临床实践中接受再次肝切除术患者的治疗情况及预后。
利用基于人群的安大略癌症登记处及相关治疗记录，确定了2002年至2009年加拿大安大略省所有因结直肠癌肝转移接受再次肝切除术的病例。
在1310例行结直肠癌肝转移灶切除术的患者中，78例（6.0%）接受了再次肝切除术。平均年龄为56岁，两次手术之间的中位时间为19个月。与首次手术相比，再次手术的病灶数量较少（2.7个对1.5个；P = .001），大手术比例较低（58%对31%；P = .024）。最大病灶大小、切缘阳性率、住院时间及90天死亡率相似。从第二次手术时起未经调整的5年总生存率为45%（95%置信区间 = 32%至59%），癌症特异性生存率为47%（95%置信区间 = 30%至64%）。
转移性结直肠癌的再次肝切除术涉及的病灶较少，手术范围较小，相当一部分患者可实现长期生存。
