Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1515 Holcombe Boulevard, TX, 77030, Houston, USA.
Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Unit 1489, 1400 Pressler Street, TX, 77030, Houston, USA.
J Gastrointest Surg. 2021 Mar;25(3):641-649. doi: 10.1007/s11605-020-04828-8. Epub 2020 Oct 29.
Long-term outcomes for simultaneous resection of synchronous colorectal liver and lung metastases are unknown. To address this gap, we compared outcomes and costs of three strategies for such resection.
Patients who underwent resection of synchronous colorectal liver and lung metastases during 2000-2018 were grouped by surgical strategy: simultaneous resection via a transdiaphragmatic approach (transdiaphragmatic) or separate abdominal and thoracic incisions (transthoracic) and nonsimultaneous staged resection (staged). Operative and postoperative outcomes, survival, cumulative lung recurrence, and surgical costs were evaluated.
The study included 63 patients, 29 with transdiaphragmatic, 14 with transthoracic, and 20 with staged resection. The groups had similar demographic and clinicopathologic characteristics. Lung resection-associated blood loss for the transdiaphragmatic group was similar to that for the transthoracic group (P = .165) but lower than that for the staged group (P = .006). Hospital stay was shorter for the simultaneous groups than for the staged group (P = .007). Median surgical costs were significantly higher in the staged group ($130,733, interquartile range [IQR] $91,109-$173,573) than in the transdiaphragmatic ($70,620, IQR $58,376-$86,203, P < .001) or transthoracic ($62,991, IQR $57,405-$98,862, P < .001) group but did not differ between the transdiaphragmatic and transthoracic groups (P = .786). Rates of postoperative complications, recurrence-free survival, overall survival, and cumulative lung recurrence were similar among the groups.
Simultaneous resection of synchronous colorectal liver and lung metastases via a transdiaphragmatic approach is associated with lower blood loss, lower costs, and similar survival compared with staged resection.
同期结直肠肝肺转移灶切除术的长期疗效尚不清楚。为了弥补这一空白，我们比较了三种手术策略治疗此类患者的疗效和成本。
回顾性分析 2000 年至 2018 年期间接受同期结直肠肝肺转移灶切除术的患者，根据手术策略分组：经膈肌入路同期切除（经膈肌组）、经胸腹联合切口同期切除（经胸组）和分期切除（分期组）。比较三组患者的手术及术后转归、生存情况、肺部复发率和手术费用。
本研究共纳入 63 例患者，其中经膈肌组 29 例，经胸组 14 例，分期组 20 例。三组患者的一般资料和临床病理特征无显著差异。经膈肌组患者肺切除术中出血量与经胸组相近（P = .165），但低于分期组（P = .006）。同期手术组患者的住院时间明显短于分期组（P = .007）。分期组患者的手术费用中位数显著高于经膈肌组（$130733，四分位间距 [IQR] $91109-173573）和经胸组（$62991，IQR $57405-98862，P < .001），但经膈肌组与经胸组间差异无统计学意义（P = .786）。三组患者术后并发症发生率、无复发生存率、总生存率和肺部复发率均无显著差异。
经膈肌入路同期切除同期结直肠肝肺转移灶可减少术中出血量，降低手术费用，与分期切除术相比，患者的生存情况无显著差异。
