Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France; Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France; Department of General Surgery, General Hospital of Veria, Greece.
Eur J Surg Oncol. 2020 Sep;46(9):1620-1627. doi: 10.1016/j.ejso.2020.05.019. Epub 2020 May 30.
Prognosis of patients with colorectal liver metastases (CRLM) is strongly correlated with the oncological outcome after liver resection. The aim of this study was to analyze the impact of laparoscopic liver resection (LLR) difficulty score (IMM difficulty score) on the oncological results in patients treated for CRLM.
All patients who underwent LLRs for CRLM from 2000 to 2016 in our department, were retrospectively reviewed. Data regarding difficulty classification, -according to the Institute Mutualiste Montsouris score (IMM)-, recurrence rate, recurrence-free survival (RFS), overall survival (OS) and data regarding margin status were analyzed.
A total of 520 patients were included. Patients were allocated into 3 groups based on IMM difficulty score of the LLR they underwent: there were 227 (43,6%), 84 (16,2%) and 209 (40,2%) patients in groups I, II and III, respectively. The R resection rate in group I, II and III were 8,8% (20/227), 11,9% (10/84) and 12,4% (26/209) respectively (p = 0.841). Three- and 5-year RFS rates were 77% and 73% in group I, 58% and 51% in group II, 61% and 53% in group III, respectively (p = 0.038). Three and 5-year OS rates were 87% and 80% for group I, 77% and 66% for group II, 80% and 69% for group III respectively (p = 0.022).
The higher LLR difficulty score correlates with significant morbidity and worse RFS and OS, although the more technically demanding and difficult cases are not associated with increased rates of positive resection margins and recurrence.
结直肠癌肝转移（CRLM）患者的预后与肝切除术后的肿瘤学结果密切相关。本研究旨在分析腹腔镜肝切除术（LLR）难度评分（IMM 难度评分）对接受 CRLM 治疗患者的肿瘤学结果的影响。
回顾性分析 2000 年至 2016 年期间在我科接受 LLR 治疗的所有 CRLM 患者。分析了难度分类（根据 Institut Mutualiste Montsouris 评分（IMM））、复发率、无复发生存率（RFS）、总生存率（OS）以及切缘状态的数据。
共纳入 520 例患者。根据接受的 LLR 的 IMM 难度评分，患者分为 3 组：I 组、II 组和 III 组分别有 227（43.6%）、84（16.2%）和 209（40.2%）例患者。I 组、II 组和 III 组的 R 切除率分别为 8.8%（20/227）、11.9%（10/84）和 12.4%（26/209）（p=0.841）。I 组、II 组和 III 组的 3 年和 5 年 RFS 率分别为 77%和 73%、58%和 51%、61%和 53%（p=0.038）。I 组、II 组和 III 组的 3 年和 5 年 OS 率分别为 87%和 80%、77%和 66%、80%和 69%（p=0.022）。
较高的 LLR 难度评分与较高的发病率以及较差的 RFS 和 OS 相关，尽管更具技术挑战性和难度的病例与阳性切缘和复发率的增加无关。
