Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
World J Surg. 2020 Aug;44(8):2743-2751. doi: 10.1007/s00268-020-05506-1.
Anatomical resection (AR) for colorectal liver metastasis (CLM) is disputable. We investigated the impact of AR on short-term outcomes and survival in CLM patients.
Patients having hepatectomy with AR or nonanatomical resection (NAR) for CLM were reviewed. Comparison was made between AR and NAR groups. Group comparison was performed again after propensity score matching with ratio 1:1.
AR group (n = 234 vs n = 89 in NAR group) had higher carcinoembryonic antigen level (20 vs 7.8 ng/mL, p ≤ 0.001), more blood loss (0.65 vs 0.2 L, p < 0.001), more transfusions (19.2% vs 3.4%, p = 0.001), longer operation (339.5 vs 180 min, p < 0.001), longer hospital stay (9 vs 6 days, p < 0.001), more tumors (p < 0.001), larger tumors (4 vs 2 cm, p < 0.001), more bilobar involvement (20.9% vs 7.9%, p = 0.006), and comparable survival (overall, p = 0.721; disease-free, p = 0.695). After propensity score matching, each group had 70 patients, with matched tumor number, tumor size, liver function, and tumor marker. AR group had more open resections (85.7% vs 68.6%, p = 0.016), more blood loss (0.556 vs 0.3 L, p = 0.001), more transfusions (17.1% vs 4.3%, p = 0.015), longer operation (310 vs 180 min, p < 0.001), longer hospital stay (8.5 vs 6 days, p = 0.002), comparable overall survival (p = 0.819), and comparable disease-free survival (p = 0.855).
Similar disease-free survival and overall survival of CLM patients were seen with the use of AR and NAR. However, AR may entail a more eventful postoperative course. NAR with margin should be considered whenever feasible.
结直肠肝转移（CLM）的解剖性切除术（AR）存在争议。本研究旨在探讨 AR 对 CLM 患者短期预后和生存的影响。
回顾性分析接受 AR 或非解剖性切除术（NAR）治疗 CLM 的患者。比较 AR 组和 NAR 组的差异。采用 1:1 比例倾向性评分匹配后再次进行组间比较。
AR 组（n=234）与 NAR 组（n=89）相比，癌胚抗原水平更高（20 vs 7.8ng/ml，p≤0.001），术中出血量更多（0.65 vs 0.2L，p<0.001），输血率更高（19.2% vs 3.4%，p=0.001），手术时间更长（339.5 vs 180min，p<0.001），住院时间更长（9 vs 6d，p<0.001），肿瘤更多（p<0.001），肿瘤更大（4 vs 2cm，p<0.001），双侧肝受累更多（20.9% vs 7.9%，p=0.006），但生存情况无显著差异（总生存，p=0.721；无疾病生存，p=0.695）。经倾向性评分匹配后，每组各有 70 例患者，两组肿瘤数量、肿瘤大小、肝功能和肿瘤标志物匹配良好。AR 组中开放性切除术更多（85.7% vs 68.6%，p=0.016），术中出血量更多（0.556 vs 0.3L，p=0.001），输血率更高（17.1% vs 4.3%，p=0.015），手术时间更长（310 vs 180min，p<0.001），住院时间更长（8.5 vs 6d，p=0.002），但总生存和无疾病生存情况无显著差异（p=0.819 和 p=0.855）。
CLM 患者使用 AR 和 NAR 的无疾病生存和总生存情况相似，但 AR 术后可能更易发生不良事件。在可行的情况下，应考虑行边缘性非解剖性切除术。
