Park Jangho, Lee Seung-Duk, Han Sung-Sik, Kim Seoung Hoon, Park Sang-Jae, Oh Jae Hwan, Joo Jungnam
Center for Liver Cancer, National Cancer Center, Goyang, Korea.
Center for Colorectal Cancer, National Cancer Center, Goyang, Korea.
Ann Surg Treat Res. 2019 Jul;97(1):7-14. doi: 10.4174/astr.2019.97.1.7. Epub 2019 Jun 26.
Liver resection is considered the only curative treatment modality for colorectal liver metastasis. The recurrence rate after hepatectomy is >50%. Two or more hepatectomies are applied to treat recurred metastases. We assessed the efficiency and feasibility of repeat hepatectomy and analyzed the prognostic factors after a repeat hepatectomy.
In total, 248 patients were diagnosed with recurred liver metastasis between January 2003 and May 2016. Second and third hepatectomies were performed in 70 and 7 patients, respectively. The other 171 patients did not undergo a repeat hepatectomy. Clinical features were collected from the medical records. We analyzed survival rates of the repeat hepatectomy group and the nonrepeat hepatectomy group. We also investigated factors affecting overall and disease-free survival of patients who received a repeat hepatectomy using univariate and multivariate analyses.
Median overall survival was significantly higher in the repeat hepatectomy group than in the nonrepeat group (83.0 months vs. 25.0 months, P < 0.001). The morbidity and mortality rates of repeat hepatectomy were 9.1% and 0%, respectively. Median overall and disease-free survival of the repeat hepatectomy group were 62.0 and 51.0 months, respectively. The number of recurred tumors was the only significant factor for disease-free survival (P = 0.029). None of the factors affected overall survival.
Repeat hepatectomy is necessary, effective, and safe for treating recurred colorectal liver metastasis. Repeat hepatectomy can be considered in patients with fewer than three recurred metastatic tumors.
肝切除术被认为是结直肠癌肝转移唯一的治愈性治疗方式。肝切除术后复发率>50%。两次或更多次肝切除术用于治疗复发性转移瘤。我们评估了再次肝切除术的有效性和可行性，并分析了再次肝切除术后的预后因素。
2003年1月至2016年5月期间，共有248例患者被诊断为复发性肝转移。分别对70例和7例患者进行了第二次和第三次肝切除术。另外171例患者未接受再次肝切除术。从病历中收集临床特征。我们分析了再次肝切除术组和未进行再次肝切除术组的生存率。我们还使用单因素和多因素分析研究了影响接受再次肝切除术患者总生存和无病生存的因素。
再次肝切除术组的中位总生存期显著高于未进行再次肝切除术组（83.0个月对25.0个月，P<0.001）。再次肝切除术的发病率和死亡率分别为9.1%和0%。再次肝切除术组的中位总生存期和无病生存期分别为62.0个月和51.0个月。复发肿瘤的数量是无病生存的唯一显著因素（P=0.029）。没有因素影响总生存。
再次肝切除术对于治疗复发性结直肠癌肝转移是必要、有效且安全的。对于复发性转移瘤少于三个的患者可考虑再次肝切除术。
