Department of Clinical Sciences Lund, Surgery, Skane University Hospital, Lund University, Lund, Sweden.
Department of Clinical Sciences Malmö, Surgery, Skane University Hospital, Lund University, Malmö, Sweden.
World J Surg. 2020 Jul;44(7):2409-2417. doi: 10.1007/s00268-020-05475-5.
About 20% of patients with colorectal cancer have liver metastases at the time of diagnosis, and surgical resection offers a chance for cure. The aim of the present study was to compare outcomes for patients that underwent simultaneous resection to those that underwent a staged procedure with the bowel-first (classical) strategy by using information from two national registries in Sweden.
In this prospectively registered cohort study, we analyzed clinical, pathological, and survival outcomes for patients operated in the period 2008-2015 and compared the two strategies.
In total, 537 patients constituted the study cohort, where 160 were treated with the simultaneous strategy and 377 with the classical strategy. Patients managed with the simultaneous strategy had less often rectal primary tumors (22% vs. 31%, p = 0.046) and underwent to a lesser extent a major liver resection (16% vs. 41%, p < 0.001), but had a shorter total length of stay (11 vs. 15 days, p < 0.001) and more complications (52% vs. 36%, p < 0.001). No significant 5-year overall survival (p = 0.110) difference was detected. Twenty-five patients had a major liver resection in the simultaneous strategy group and 155 in the classical strategy group without difference in 5-year overall survival (p = 0.198).
Simultaneous resection of the colorectal primary cancer and liver metastases can possibly have more complications, with no difference in overall survival compared to the classical strategy.
约 20%的结直肠癌患者在诊断时已发生肝转移，手术切除为治愈提供了机会。本研究旨在比较使用瑞典两个国家登记处的数据，同时行结直肠原发灶和肝脏转移灶切除术（同步策略）与分步行结直肠原发灶切除术和肝脏转移灶切除术（经典策略）的患者结局。
本前瞻性注册队列研究分析了 2008-2015 年期间手术治疗的患者的临床、病理和生存结局，并比较了这两种策略。
共纳入 537 例患者，其中 160 例采用同步策略，377 例采用经典策略。采用同步策略的患者直肠原发肿瘤较少（22% vs. 31%，p=0.046），肝切除范围较小（16% vs. 41%，p<0.001），但总住院时间较短（11 天 vs. 15 天，p<0.001），并发症更多（52% vs. 36%，p<0.001）。两组患者 5 年总生存率无显著差异（p=0.110）。在同步策略组中有 25 例患者行大范围肝切除术，而在经典策略组中有 155 例患者行大范围肝切除术，但两组患者的 5 年总生存率无差异（p=0.198）。
同时行结直肠原发灶和肝脏转移灶切除术可能会导致更多的并发症，但与经典策略相比，总生存率无差异。
