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微波消融治疗结直肠癌肝转移:三级医院中10毫米安全切缘对局部复发的影响

Microwave ablation of colorectal liver metastases: Impact of a 10-mm safety margin on local recurrence in a tertiary care hospital.

作者信息

Ausania Fabio, Borin Alex, Melendez Reyes, Rio Paula Senra Del, Iglesias Alfonso, Bodenlle Pilar, Paniagua Marta, Arias Mercedes

机构信息

Hepatopancreatobiliary Surgery Unit, Department of Digestive Surgery, Vigo University Hospital, Vigo, Spain.

Liver Transplant Unit, Department of Surgery, Verona University Hospital, Verona, Italy.

出版信息

Ann Hepatobiliary Pancreat Surg. 2021 Aug 31;25(3):366-370. doi: 10.14701/ahbps.2021.25.3.366.

Abstract

Microwave ablation (MWA) for colorectal liver metastasis (CLM) has been traditionally considered inferior to surgery due to the higher rate of local recurrence. The study investigated whether a safety margin of 10 mm can improve local control in patients undergoing surgical MWA. Surgical MWA was used to treat 53 lesions in 22 patients with CLM at our Institution from June 2012 to June 2017. The patients' mean age was 64.5 years, and the median size of the lesion was 16.5 mm (9-34 mm). MWA was associated with liver resection in 16 patients (72.7%). The median follow-up was 32.4 months. Univariate and multivariate analyses were performed to identify factors associated with tumor recurrence. Median ablation area was 36.6 mm (30-50 mm). The complication rate was 22.7%. No local recurrence was observed during follow-up. Disease-free survival was 20 months (4.8-55.2 months). Univariate analysis revealed that the number of liver metastases and node-positive primary tumors were associated with tumor recurrence. Multivariate analysis revealed that node-positive primary tumor was the only factor significantly associated with tumor recurrence ( = 0.049; odds ratio, 12; 95% confidence interval, 1-143). When performed with a 10-mm safety margin, surgical MWA can lead to acceptable oncological outcomes with low morbidity. Therefore, it represents a good option in selected patients with CLM.

摘要

由于局部复发率较高,传统上认为微波消融(MWA)治疗结直肠癌肝转移(CLM)不如手术治疗。本研究调查了10毫米的安全切缘是否能改善接受手术MWA患者的局部控制情况。2012年6月至2017年6月,我们机构采用手术MWA治疗了22例CLM患者的53个病灶。患者的平均年龄为64.5岁,病灶的中位大小为16.5毫米(9 - 34毫米)。16例患者(72.7%)的MWA与肝切除术相关。中位随访时间为32.4个月。进行单因素和多因素分析以确定与肿瘤复发相关的因素。中位消融面积为36.6毫米(30 - 50毫米)。并发症发生率为22.7%。随访期间未观察到局部复发。无病生存期为20个月(4.8 - 55.2个月)。单因素分析显示肝转移灶数量和原发肿瘤淋巴结阳性与肿瘤复发相关。多因素分析显示原发肿瘤淋巴结阳性是与肿瘤复发显著相关的唯一因素( = 0.049;比值比,12;95%置信区间,1 - 143)。当采用10毫米安全切缘进行手术MWA时,可获得可接受的肿瘤学结果且发病率较低。因此,对于选定的CLM患者,它是一个很好的选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d50/8382861/fa7acadb21ec/ahbps-25-3-366-f1.jpg

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