Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: https://twitter.com/DTsilimigras.
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Surgery. 2021 Jul;170(1):160-166. doi: 10.1016/j.surg.2021.01.041. Epub 2021 Mar 3.
The objective of this study was to assess trends in the use as well as the outcomes of patients undergoing simultaneous versus staged resection for synchronous colorectal liver metastases.
Patients undergoing resection for colorectal liver metastases between 2008 and 2018 were identified using a multi-institutional database. Trends in use and outcomes of simultaneous resection of colorectal liver metastases were examined over time and compared with that of staged resection after propensity score matching.
Among 1,116 patients undergoing resection for colorectal liver metastases, 690 (61.8%) patients had synchronous disease. Among them, 314 (45.5%) patients underwent simultaneous resection, while 376 (54.5%) had staged resection. The proportion of patients undergoing simultaneous resection for synchronous colorectal liver metastases increased over time (2008: 37.2% vs 2018: 47.4%; p = 0.02). After propensity score matching (n = 201 per group), patients undergoing simultaneous resection for synchronous colorectal liver metastases had a higher incidence of overall (44.8% vs 34.3%; P = .03) and severe complications (Clavien-Dindo ≥III) (16.9% vs 7.0%; P = .002) yet comparable 90-day mortality (3.5% vs 1.0%; P = .09) compared with patients undergoing staged resection. The incidence of severe morbidity decreased over time (2008: 50% vs 2018: 11.1%; p = 0.02). Survival was comparable among patients undergoing simultaneous versus staged resection of colorectal liver metastases (3-year overall survival: 66.1% vs 62.3%; P = .67). Following simultaneous resection, severe morbidity and mortality increased incrementally based on the extent of liver resection and complexity of colectomy.
While simultaneous resection was associated with increased morbidity, the incidence of severe morbidity decreased over time. Long-term survival was comparable after simultaneous resection versus staged resection of colorectal liver metastases.
本研究旨在评估同时与分期切除治疗结直肠肝转移同步性患者的应用趋势和结局。
通过多机构数据库确定 2008 年至 2018 年间接受结直肠肝转移切除术的患者。随着时间的推移，检查同时切除结直肠肝转移的使用和结果趋势，并与分期切除后的倾向评分匹配进行比较。
在 1116 例接受结直肠肝转移切除术的患者中，690 例（61.8%）患者患有同步性疾病。其中，314 例（45.5%）患者接受了同期切除术，376 例（54.5%）患者接受了分期切除术。同期切除治疗同步性结直肠肝转移的患者比例随时间推移而增加（2008 年：37.2%vs2018 年：47.4%；p=0.02）。在倾向评分匹配后（每组 201 例），同期切除治疗同步性结直肠肝转移的患者总并发症发生率更高（44.8%vs34.3%；P=0.03）和严重并发症（Clavien-Dindo ≥III 级）发生率更高（16.9%vs7.0%；P=0.002），但 90 天死亡率相当（3.5%vs1.0%；P=0.09）。严重发病率随时间推移而降低（2008 年：50%vs2018 年：11.1%；p=0.02）。同期与分期切除治疗结直肠肝转移的患者生存情况相当（3 年总生存率：66.1%vs62.3%；P=0.67）。同期切除后，肝切除术范围和结肠切除术复杂性增加，严重发病率和死亡率呈递增趋势。
虽然同期切除与发病率增加相关，但严重发病率随时间推移而降低。同期与分期切除治疗结直肠肝转移的患者长期生存情况相当。
