Oregon Heath & Science University (OHSU), School of Medicine, Portland, OR, 97239, USA.
Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA.
Am J Surg. 2021 Jun;221(6):1114-1118. doi: 10.1016/j.amjsurg.2021.03.007. Epub 2021 Mar 8.
Resected colorectal liver metastases (CRLM) frequently recur intrahepatically. Selection criteria for repeat hepatectomy of recurrent CRLM are ill-defined.
We performed an institutional review of patients with recurrent CRLM undergoing repeat hepatectomy from 2003 to 19. Post-recurrence overall (rOS) and recurrence-free survival (RFS) were analyzed with Cox proportional hazards modeling.
n = 147 experienced recurrent CRLM; 11% (n = 38) received repeat hepatectomy of which there was one Clavien-Dindo IIIa complication. Median rOS was 41 months; median RFS was 9 months. Improved rOS and RFS were independently associated with additional post-operative chemotherapy after repeat hepatectomy (HR 0.35 and 0.34, respectively); poor rOS with recurrent CRLM >3 cm (HR 4.4) and <12 months from first hepatectomy to recurrence (HR 4.8); poor RFS with ≥3 recurrence liver metastases (HR 2.8) (All P < 0.05).
Repeat hepatectomy for recurrent CRLM can be performed safely. Worse survival following repeat hepatectomy is independently associated with >3 cm and ≥3 liver lesions at recurrence, and <12 months to recurrence. Additional post-operative chemotherapy after repeat hepatectomy is associated with improved outcomes.
切除的结直肠肝转移（CRLM）常在肝内复发。复发性 CRLM 再次肝切除的选择标准尚未明确。
我们对 2003 年至 2019 年间因复发性 CRLM 行再次肝切除术的患者进行了机构审查。采用 Cox 比例风险模型分析复发性总体生存（rOS）和无复发生存（RFS）。
n=147 例患者发生复发性 CRLM；11%（n=38）接受了再次肝切除术，其中有 1 例出现 Clavien-Dindo IIIa 并发症。中位 rOS 为 41 个月；中位 RFS 为 9 个月。再次肝切除术后接受辅助化疗与 rOS 和 RFS 的改善独立相关（HR 分别为 0.35 和 0.34）；复发性 CRLM >3cm（HR 4.4）和首次肝切除至复发时间<12 个月（HR 4.8）与 rOS 较差相关；≥3 个肝转移复发与 RFS 较差相关（HR 2.8）（均 P<0.05）。
复发性 CRLM 再次肝切除是安全的。再次肝切除后生存较差与复发时>3cm 和≥3 个肝病灶以及<12 个月至复发时间有关。再次肝切除术后接受辅助化疗与改善结局相关。
