结直肠癌双叶肝转移灶二期肝切除术的可行性、安全性及疗效：一项LiverMetSurvey分析
Feasibility, safety and efficacy of two-stage hepatectomy for bilobar liver metastases of colorectal cancer: a LiverMetSurvey analysis.
作者信息
Regimbeau Jean Marc, Cosse Cyril, Kaiser Gernot, Hubert Catherine, Laurent Christophe, Lapointe Real, Isoniemi Helen, Adam Rene
机构信息
Digestive and Oncological Surgery Department, Amiens University Medical Center, Amiens, France; EA 4292, Jules Verne University of Picardy, Amiens, France; Clinical Research Center, Amiens University Medical Center, Amiens, France.
Digestive and Oncological Surgery Department, Amiens University Medical Center, Amiens, France; Clinical Research Center, Amiens University Medical Center, Amiens, France.
出版信息
HPB (Oxford). 2017 May;19(5):396-405. doi: 10.1016/j.hpb.2017.01.008. Epub 2017 Mar 23.
BACKGROUND
The combination of liver resection and chemotherapy has become the standard of care for colorectal liver metastases (LM). The objective of the present study was to evaluate the impact of two-stage hepatectomy (TSH) on the long-term survival of patients with bilobar LM.
METHODS
We included adult (over-18) patients from the LiverMetSurvey registry with confirmed multiple colorectal LM and having undergone either one-stage hepatectomy or TSH with curative intent. The "TSH (2/2)" group (n = 625) comprised patients having completed both stages of TSH; the "TSH (1/2)" group (n = 244) comprised patients having undergone only the first stage of TSH; the "hepatectomy" group. The primary outcome criterion was the overall survival (OS). The secondary outcomes were the morbidity and mortality rates.
RESULTS
The 30- and 90-day mortality rates were respectively 3.8% and 9.3% in the TSH (2/2) group, 9.4% and 16.4% in the TSH (1/2) group, and 5.4% and 9.1% in the "hepatectomy" group. The three-year OS rate was 45% in the TSH (2/2) group, 30% in the TSH (1/2) group and 50.7% in the hepatectomy group.
CONCLUSION
The LiverMetSurvey registry's data indicate that TSH is associated with rather good long-term survival and acceptable morbidity and mortality rates.
背景
肝切除与化疗相结合已成为结直肠癌肝转移（LM）的标准治疗方案。本研究的目的是评估两阶段肝切除术（TSH）对双叶LM患者长期生存的影响。
方法
我们纳入了LiverMetSurvey登记处的成年（18岁以上）患者，这些患者确诊为多发结直肠癌肝转移，并接受了一期肝切除术或具有治愈目的的两阶段肝切除术。“TSH（2/2）”组（n = 625）包括完成两阶段TSH的患者；“TSH（1/2）”组（n = 244）包括仅接受TSH第一阶段手术的患者；“肝切除术”组。主要结局标准是总生存期（OS）。次要结局是发病率和死亡率。
结果
TSH（2/2）组的30天和90天死亡率分别为3.8%和9.3%，TSH（1/2）组分别为9.4%和16.4%，“肝切除术”组分别为5.4%和9.1%。TSH（2/2）组的三年总生存率为45%，TSH（1/2）组为30%，肝切除术组为50.7%。
结论
LiverMetSurvey登记处的数据表明，两阶段肝切除术与相当好的长期生存率以及可接受的发病率和死亡率相关。
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