Wurster Elena F, Tenckhoff Solveig, Probst Pascal, Jensen Katrin, Dölger Eva, Knebel Phillip, Diener Markus K, Büchler Markus W, Ulrich Alexis
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
HPB (Oxford). 2017 Jun;19(6):491-497. doi: 10.1016/j.hpb.2017.02.440. Epub 2017 Mar 25.
Recurrence of colorectal liver metastases after a first hepatectomy is common (4-48% of patients). This review investigates the utility of repeated hepatic resection of colorectal liver metastases.
A systematic search of the literature was performed in the Cochrane Library, MEDLINE, EMBASE, and trial registers. All studies comparing repeated hepatic resection for colorectal liver metastases with patients who underwent only one hepatectomy were eligible. Outcome criteria were safety parameters and survival rates. Data were analyzed using the random-effects model.
In eight observational clinical studies, 450 patients with repeated hepatic resection were compared with 2669 single hepatic resections. Morbidity such as hepatic insufficiency (OR [95% CI] 1.46 [0.69; 3.08], p = 0.32) and biliary leakage and fistula (OR [95% CI] 1.22 [0.80; 1.85], p = 0.35) was comparable between the two groups. Mortality (OR [95% CI] 1.13 [0.46; 2.74], p = 0.79) and overall survival (HR [95% CI] 1.00 [0.63; 1.60], p = 0.99) were not significantly different between the two groups.
Repeated hepatic resection for colorectal liver metastases is safe in selected patients. A prospective, multicenter high-quality trial or register study of repeated hepatic resection will be required to clarify patient-oriented outcomes such as overall survival and quality of life.
首次肝切除术后结直肠癌肝转移复发很常见（4% - 48%的患者）。本综述探讨了再次肝切除治疗结直肠癌肝转移的效用。
在Cochrane图书馆、MEDLINE、EMBASE和试验注册库中对文献进行系统检索。所有比较结直肠癌肝转移再次肝切除与仅接受一次肝切除患者的研究均符合条件。结局标准为安全参数和生存率。采用随机效应模型分析数据。
在八项观察性临床研究中，将450例行再次肝切除的患者与2669例行单次肝切除的患者进行了比较。两组之间诸如肝功能不全（比值比[95%置信区间]1.46[0.69；3.08]，p = 0.32）、胆漏和胆瘘（比值比[95%置信区间]1.22[0.80；1.85]，p = 0.35）等并发症发生率相当。两组之间的死亡率（比值比[95%置信区间]1.13[0.46；2.74]，p = 0.79）和总生存率（风险比[95%置信区间]1.00[0.63；1.60]，p = 0.99）无显著差异。
对于选定的患者，结直肠癌肝转移再次肝切除是安全的。需要进行一项关于再次肝切除的前瞻性、多中心高质量试验或注册研究，以明确以患者为导向的结局，如总生存率和生活质量。
