Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56 20089, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 20072, Pieve Emanuele, Milan, Italy.
J Gastrointest Surg. 2022 Mar;26(3):570-582. doi: 10.1007/s11605-021-05123-w. Epub 2021 Sep 10.
Liver resection for colorectal metastases is affected by a non-negligible recurrence rate. The earlier the recurrence, the worse the prognosis. We analyzed an unexplored topic, i.e., the incidence, predictive factors, and prognostic impact of very early recurrence (≤ 3 months after hepatectomy).
All consecutive liver resections for colorectal metastases performed between 2004 and 2017 were retrospectively reviewed. Inclusion criteria were available recurrence status at 3 months after resection and follow-up ≥ 12 months.
Overall, 484 patients were analyzed; 56 (11.6%) had very early recurrence. Independent predictors were number of metastases (very early recurrence in 3.7% of patients with solitary metastasis, 8.1% of those with 2-9 metastases; 20.0% of those with 10-14 metastases; 44.4% of those with ≥ 15 metastases, p < 0.001) and extrahepatic disease (very early recurrence in 23.2% of patients with vs. 10.1% of those without extrahepatic disease, p = 0.017). Very early recurrence rate in patients with ≥ 15 metastases and simultaneous extrahepatic disease was 71.4%. Patients with very early recurrence had poor survival (5-year survival 17.3% vs. 44.5% of non-very early recurrence patients, p < 0.001), worse than patients with 3-to-6 months recurrence (p = 0.070), and no different from unresected patients (p = 0.114). Fifteen patients with very early recurrence (26.8%) underwent repeated treatment with adequate survival (at 3 years 42.2%), but seven had a further recurrence within 3 months.
Very early recurrence occurs in about 12% of patients undergoing aggressive surgery for colorectal metastases. The risk is increased in patients with numerous metastases or extrahepatic disease. Very early recurrence is associated with very poor prognosis, similar to that of unresected patients, and a low chance of effective repeated treatment.
结直肠癌肝转移患者行肝切除术的复发率不可忽视，复发时间越早，预后越差。我们分析了一个尚未探索的话题，即早期复发（肝切除术后 3 个月内）的发生率、预测因素和预后影响。
回顾性分析 2004 年至 2017 年间连续行肝切除术治疗的结直肠癌肝转移患者。纳入标准为术后 3 个月内有复发且随访时间≥12 个月。
共分析 484 例患者，56 例（11.6%）发生早期复发。独立预测因素为转移灶数量（单发转移患者中早期复发率为 3.7%，2-9 个转移灶患者为 8.1%，10-14 个转移灶患者为 20.0%，≥15 个转移灶患者为 44.4%，p<0.001）和肝外疾病（有肝外疾病患者的早期复发率为 23.2%，无肝外疾病患者为 10.1%，p=0.017）。同时有≥15 个转移灶和肝外疾病的患者早期复发率为 71.4%。早期复发患者的生存较差（5 年生存率 17.3%vs.非早期复发患者的 44.5%，p<0.001），比 3-6 个月复发患者差（p=0.070），与未行手术切除的患者无差异（p=0.114）。15 例早期复发（26.8%）患者接受了充分的重复治疗，生存时间较长（3 年生存率为 42.2%），但其中 7 例在 3 个月内再次复发。
约 12%接受积极手术治疗的结直肠癌肝转移患者发生早期复发。有多个转移灶或肝外疾病的患者风险增加。早期复发与预后极差相关，与未手术切除的患者相似，且有效重复治疗的机会较低。
