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原发性结直肠癌与同步性肝转移瘤的同期切除:当代实践、证据与知识空白

Simultaneous Resection of Primary Colorectal Cancer and Synchronous Liver Metastases: Contemporary Practice, Evidence and Knowledge Gaps.

作者信息

Kleive Dyre, Aas Eline, Angelsen Jon-Helge, Bringeland Erling A, Nesbakken Arild, Nymo Linn S, Schultz Johannes K, Søreide Kjetil, Yaqub Sheraz

机构信息

Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway.

Department of Health Management and Health Economics (HELED), Institute of Health and Society, University of Oslo, Oslo, Norway.

出版信息

Oncol Ther. 2021 Jun;9(1):111-120. doi: 10.1007/s40487-021-00148-2. Epub 2021 Mar 23.

Abstract

The timing of surgical resection of synchronous liver metastases from colorectal cancer has been debated for decades. Several strategies have been proposed, but high-level evidence remains scarce. Simultaneous resection of the primary tumour and liver metastases has been described in numerous retrospective audits and meta-analyses. The potential benefits of simultaneous resections are the eradication of the tumour burden in one procedure, overall shorter procedure time, reduced hospital stay with the likely benefits on quality of life and an expected reduction in the use of health care services compared to staged procedures. However, concerns about accumulating complications and oncological outcomes remain and the optimal selection criteria for whom simultaneous resections are beneficial remains undetermined. Based on the current level of evidence, simultaneous resection should be restricted to patients with a limited liver tumour burden. More high-level evidence studies are needed to evaluate the quality of life, complication burden, oncological outcomes, as well as overall health care implications for simultaneous resections.

摘要

几十年来,结直肠癌同时性肝转移的手术切除时机一直存在争议。已经提出了几种策略,但高水平证据仍然稀缺。在众多回顾性审计和荟萃分析中都描述了同时切除原发性肿瘤和肝转移灶的情况。与分期手术相比,同时切除的潜在益处包括在一次手术中消除肿瘤负荷、总体手术时间更短、住院时间缩短,这可能对生活质量有益,并且预计医疗服务的使用会减少。然而,对累积并发症和肿瘤学结果的担忧仍然存在,同时切除对哪些患者有益的最佳选择标准仍未确定。基于目前的证据水平,同时切除应仅限于肝肿瘤负荷有限的患者。需要更多高水平的证据研究来评估同时切除对生活质量、并发症负担、肿瘤学结果以及整体医疗保健的影响。

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