Department of Surgery, Institut Paoli-Calmettes, Marseille, France.
Department of Surgery, Institut Paoli-Calmettes, Marseille, France.
HPB (Oxford). 2019 Nov;21(11):1478-1484. doi: 10.1016/j.hpb.2019.03.357. Epub 2019 Apr 6.
Two-stage hepatectomy (TSH) strategy is used to treat patients with bilobar colorectal liver metastasis (CLM). However, many patients do not undergo the second hepatectomy owing to disease progression in the future liver remnant (FLR) after portal vein embolization (PVE). This study aimed to assess the impact of disease progression in the FLRs of patients who completed the first hepatectomy.
68 consecutive patients underwent the first hepatectomy followed by PVE. Six patients (9%) dropped out after the PVE (two-stage failed [TSF] group) because of unresectable hepatic or general disease progression. Seventeen patients (25%) completed their second hepatectomy despite disease progression in the FLR (new CLM [nCLM] group) as it was considered resectable, while 45 patients (66%) underwent the second hepatectomy (control group).
The 5-year overall survival rates in the TSF, nCLM, and control groups were 0%, 7%, and 60%, respectively (P < 0.001). The median overall survival times between the TSF and nCLM groups were 26 months and 42 months (P = 0.005). Patients in the nCLM group whose hepatic disease progression was detected preoperatively versus intraoperatively had comparable survival rates.
Resectable hepatic disease progression in the FLR after PVE should not be considered a contraindication for the second hepatectomy.
两阶段肝切除术（TSH）策略用于治疗双侧结直肠癌肝转移（CLM）患者。然而，许多患者由于门静脉栓塞（PVE）后剩余肝（FLR）中的疾病进展而无法进行第二次肝切除术。本研究旨在评估完成第一次肝切除术后FLR 中疾病进展对患者的影响。
68 例连续患者接受了第一次肝切除术，随后进行了 PVE。6 例（9%）患者在 PVE 后因肝内或全身不可切除疾病进展而退出（两阶段失败 [TSF] 组）。17 例（25%）患者尽管 FLR 中存在疾病进展，但仍完成了第二次肝切除术（新 CLM [nCLM] 组），因为认为其可切除，而 45 例（66%）患者接受了第二次肝切除术（对照组）。
TSF、nCLM 和对照组的 5 年总生存率分别为 0%、7%和 60%（P<0.001）。TSF 和 nCLM 组之间的中位总生存时间分别为 26 个月和 42 个月（P=0.005）。nCLM 组中术前和术中发现肝内疾病进展的患者具有相似的生存率。
PVE 后 FLR 中可切除的肝内疾病进展不应被视为第二次肝切除术的禁忌症。
