Department of Surgery, General and Hepatobiliary Surgery, University of Verona, University Hospital G.B. Rossi, 37134, Verona, Italy.
Department of Surgery, General and Hepatobiliary Surgery, University of Verona, University Hospital G.B. Rossi, 37134, Verona, Italy.
Eur J Surg Oncol. 2021 Apr;47(4):842-849. doi: 10.1016/j.ejso.2020.09.015. Epub 2020 Sep 25.
We aimed to investigate the impact of the site of the primary on postoperative and oncological outcomes in patients undergone simultaneous approach for colon (CC) and rectal cancer (RC) with synchronous liver metastases (SCRLM).
Of the 220 patients with SCRLM operated on between Mar 2006 and Dec 2017, 169 patients (76.8%) were treated by a simultaneous approach and were included in the study. Two groups were considered according to the location of primary tumor RC-Group (n = 47) and CC-group (n = 122).
Multiple liver metastases were observed in 70.2% in RC-Group and 77.0% in CC-Group (p = 0.233), whilst median Tumor Burden Score (TBS) was 4.7 in RC-Group and 5.4 CC-Group (p = 0.276). Severe morbidity (p = 0.315) and mortality at 90 days (p = 0.520) were comparable between RC-Group and CC-Group. The 5-year overall survival (OS) rate was similar comparing RC-Group and CC-Group (48.2% vs. 45.3%; p = 0.709), but it was significantly different when considering left-CC, right-CC and RC separately (54.5% vs. 35.2% vs. 48.2%; p = 0.041). Primary tumor location (right-CC, p = 0.001; RC, p = 0.002), microscopic residual (R1) disease at the primary (p < 0.001), TBS ≥6 (p = 0.012), bilobar metastases (p = 0.004), and chemotherapy strategy (preoperative ChT, p = 0.253; postoperative ChT, p = 0.012; and perioperative ChT, p < 0.001) resulted to be independent prognostic factors at multivariable analysis.
In patients with SCRLM, simultaneous resection of the primary tumor and liver metastases seems feasible and safe and allows satisfactory oncological outcomes both in CC and RC. Right-CC shows a worse prognosis when compared to left-CC and RC.
本研究旨在探讨结肠癌（CC）和直肠癌（RC）同时合并肝转移（SCRLM）患者，采用同期手术治疗时，原发肿瘤部位对术后和肿瘤学结局的影响。
2006 年 3 月至 2017 年 12 月，220 例 SCRLM 患者接受手术治疗，其中 169 例（76.8%）采用同期手术治疗，并纳入本研究。根据原发肿瘤的位置，将患者分为 RC 组（n=47）和 CC 组（n=122）。
RC 组和 CC 组中分别有 70.2%和 77.0%的患者存在多发肝转移（p=0.233），中位肿瘤负荷评分（TBS）分别为 4.7 和 5.4（p=0.276）。RC 组和 CC 组的严重并发症发生率（p=0.315）和 90 天死亡率（p=0.520）相当。比较 RC 组和 CC 组的 5 年总生存率（OS），结果相似（48.2% vs. 45.3%；p=0.709），但当分别考虑左半结肠 CC、右半结肠 CC 和 RC 时，结果存在显著差异（54.5% vs. 35.2% vs. 48.2%；p=0.041）。原发肿瘤位置（右半结肠 CC，p=0.001；RC，p=0.002）、原发肿瘤的镜下切缘阳性（R1）（p<0.001）、TBS≥6（p=0.012）、双叶转移（p=0.004）和化疗策略（术前化疗，p=0.253；术后化疗，p=0.012；围手术期化疗，p<0.001）是多变量分析的独立预后因素。
对于 SCRLM 患者，同期切除原发肿瘤和肝脏转移灶是可行且安全的，可在 CC 和 RC 中获得满意的肿瘤学结局。与左半结肠 CC 和 RC 相比，右半结肠 CC 的预后较差。
