Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Am Coll Surg. 2018 May;226(5):825-834. doi: 10.1016/j.jamcollsurg.2018.01.054. Epub 2018 Feb 14.
Both 2-stage hepatectomy (TSH) and 1-stage hepatectomy (OSH) represent feasible strategies for resection of advanced bilobar colorectal liver metastases (CLM). However, the influence of the surgical approach on postoperative outcomes and overall survival (OS) is unknown. To define the optimal surgical approach for advanced bilobar CLM requiring right hemihepatectomy, we compared short-term and long-term outcomes after TSH and OSH with contralateral resection or radiofrequency ablation (RFA).
We retrospectively reviewed 227 patients with bilobar CLM, who underwent right or extended right hepatectomy with treatment of synchronous CLM in segments I, II, and/or III, between 1998 and 2015. Postoperative outcomes and OS were compared between patients who underwent TSH and those who underwent OSH.
Of the 227 patients, 126 (56%) underwent at least the first stage of TSH, and 101 (44%) underwent OSH, 29 (13%) without RFA and 72 (32%) with RFA. Two-stage hepatectomy was associated with a lower incidence of postoperative major complications (14% vs 26%, p = 0.03) and postoperative hepatic insufficiency (6% vs 20%, p = 0.001) than OSH. The 5-year OS rate was higher for patients assigned to TSH than for those who underwent OSH (35% vs 24%, p = 0.016). Patients who completed both stages of TSH had a higher 5-year OS rate than patients who underwent OSH without RFA (50% vs 20%, p = 0.023) or OSH with RFA (50% vs 24%, p < 0.0001).
In patients with advanced bilobar CLM, TSH is associated with fewer complications than OSH. Both TSH in intention-to-treat analysis and completed TSH in as-treated analysis were associated with better OS than OSH.
两阶段肝切除术（TSH）和一阶段肝切除术（OSH）均是治疗进展期双侧结直肠癌肝转移（CLM）的可行策略。然而，手术方式对术后结果和总生存期（OS）的影响尚不清楚。为了明确需要行右半肝切除术的进展期双侧 CLM 的最佳手术方式，我们比较了 TSH 和 OSH 与对侧切除术或射频消融（RFA）治疗后的短期和长期结果。
我们回顾性分析了 1998 年至 2015 年间接受右半肝或扩大右半肝切除术且同时治疗 I、II 和/或 III 段同步 CLM 的 227 例双侧 CLM 患者的资料。比较了 TSH 组和 OSH 组患者的术后结果和 OS。
227 例患者中，126 例（56%）至少完成了 TSH 的第一阶段，101 例（44%）行 OSH，其中 29 例（13%）未行 RFA，72 例（32%）行 RFA。TSH 组术后主要并发症发生率（14% vs. 26%，p=0.03）和术后肝功能不全发生率（6% vs. 20%，p=0.001）低于 OSH 组。分配至 TSH 组的患者 5 年 OS 率高于 OSH 组（35% vs. 24%，p=0.016）。完成 TSH 两阶段治疗的患者 5 年 OS 率高于未行 RFA 的 OSH 组（50% vs. 20%，p=0.023）或行 RFA 的 OSH 组（50% vs. 24%，p<0.0001）。
在进展期双侧 CLM 患者中，TSH 与 OSH 相比，并发症更少。意向治疗分析中的 TSH 以及实际治疗分析中的完成 TSH 均与 OSH 相比具有更好的 OS。
