Maeda Yoshiaki, Shinohara Toshiki, Minagawa Nozomi, Koyama Ryota, Nagatsu Akihisa, Shimada Shingo, Hamada Tomonori
Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Department of Surgery, Hokkaido Cancer Center, 4-2-3-54 Kikusui, Shiroishi, Sapporo, 003-0804, Japan.
Ann Med Surg (Lond). 2020 Jan 22;52:24-30. doi: 10.1016/j.amsu.2020.01.006. eCollection 2020 Apr.
Although hepatectomy is the standard and only curative treatment for colorectal liver metastases, recurrence occurs in various organs, including the remnant liver, lung, peritoneum, and others. The outcomes and predictive factors of repeat metastasectomy for recurrence after initial hepatectomy remains controversial.
We retrospectively assessed a consecutive series of 132 patients who underwent hepatectomy for colorectal liver metastases in a single institute.
There were 99 recurrence cases after initial hepatectomy, and 42 patients underwent metastasectomy (first repeat metastasectomy) to achieve R0 (17 liver cases, 16 lung cases, and 9 multiple or other cases), while 19 patients underwent subsequent second repeat metastasectomy (4 liver cases, 7 lung cases, and 8 multiple or other cases). Among the 99 recurrent cases after initial hepatectomy, the 5-year overall survival rate of the patients who underwent first repeat metastasectomy was significantly higher than that of chemotherapy/BSC (best supportive care) patients (60% vs. 14%, P < 0.0001). Furthermore, among the 26 recurrent cases after first repeat metastasectomy, the 5-year overall survival rate of the patients who underwent second repeat metastasectomy was significantly higher than that of chemotherapy/BSC patients (P = 0.024). A multivariate analysis revealed that lack of adjuvant chemotherapy, a short (<12 months) disease-free interval, and right-side colon primary were the independent poor prognostic factors for the overall survival after first repeat metastasectomy.
The current study indicated that repeat metastasectomy for recurrence after initial hepatectomy for colorectal liver metastases could achieve a longer survival time, especially for patients with favorable predictive factors.
尽管肝切除术是结直肠癌肝转移的标准且唯一的根治性治疗方法，但复发仍会出现在包括残余肝脏、肺、腹膜等在内的多个器官。初次肝切除术后复发再次行转移灶切除术的疗效及预测因素仍存在争议。
我们回顾性评估了在单一机构接受结直肠癌肝转移肝切除术的连续132例患者。
初次肝切除术后有99例复发，42例患者接受了转移灶切除术（首次再次转移灶切除术）以达到R0切除（17例肝脏转移、16例肺转移以及9例多发或其他部位转移），19例患者随后接受了第二次再次转移灶切除术（4例肝脏转移、7例肺转移以及8例多发或其他部位转移）。在初次肝切除术后的99例复发病例中，接受首次再次转移灶切除术患者的5年总生存率显著高于接受化疗/最佳支持治疗（BSC）的患者（60%对14%，P<0.0001）。此外，在首次再次转移灶切除术后的26例复发病例中，接受第二次再次转移灶切除术患者的5年总生存率显著高于接受化疗/BSC的患者（P=0.024）。多因素分析显示，未接受辅助化疗、无病间期短（<12个月）以及原发灶位于右半结肠是首次再次转移灶切除术后总生存的独立不良预后因素。
当前研究表明，初次肝切除术后复发的结直肠癌肝转移患者再次行转移灶切除术可获得更长的生存时间，尤其是具有良好预测因素的患者。
