研究:国际多中心微创肝切除术治疗结直肠癌肝转移(SIMMILR-CRLM)
Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM).
作者信息
Gumbs Andrew A, Lorenz Eric, Tsai Tzu-Jung, Starker Lee, Flanagan Joe, Benedetti Cacciaguerra Andrea, Yu Ng Jing, Bajul Melinda, Chouillard Elie, Croner Roland, Abu Hilal Mohammad
机构信息
Departement de Chirurgie Digestive, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye 10, Rue du Champ Gaillard, 78300 Poissy, France.
Department of General-, Visceral-, Vascular- and Transplantation Surgery, University of Magdeburg, Haus 60a, Leipziger Str. 44, 39120 Magdeburg, Germany.
出版信息
Cancers (Basel). 2022 Mar 8;14(6):1379. doi: 10.3390/cancers14061379.
(1) Background: Here we report on a retrospective study of an international multicentric cohort after minimally invasive liver resection (SIMMILR) of colorectal liver metastases (CRLM) from six centers. (2) Methods: Resections were divided by the approach used: open liver resection (OLR), laparoscopic liver resection (LLR) and robotic liver resection (RLR). Patients with macrovascular invasion, more than three metastases measuring more than 3 cm or a solitary metastasis more than 5 cm were excluded, and any remaining heterogeneity found was further analyzed after propensity score matching (PSM) to decrease any potential bias. (3) Results: Prior to matching, 566 patients underwent OLR, 462 LLR and 36 RLR for CRLM. After PSM, 142 patients were in each group of the OLR vs. LLR group and 22 in the OLR vs. RLR and 21 in the LLR vs. RLR groups. Blood loss, hospital stay, and morbidity rates were all highly statistically significantly increased in the OLR compared to the LLR group, 636 mL vs. 353 mL, 9 vs. 5 days and 25% vs. 6%, respectively (p < 0.001). Only blood loss was significantly decreased when RLR was compared to OLR and LLR, 250 mL vs. 597 mL, and 224 mL vs. 778 mL, p < 0.008 and p < 0.04, respectively. (4) Conclusions: SIMMILR indicates that minimally invasive approaches for CRLM that follow the Milan criteria may have short term advantages. Notably, larger studies with long-term follow-up comparing robotic resections to both OLR and LLR are still needed.
(1) 背景:在此,我们报告一项对来自六个中心的结直肠癌肝转移(CRLM)患者进行微创肝切除术后的国际多中心队列(SIMMILR)的回顾性研究。(2) 方法:根据所采用的手术方式将肝切除术分为:开腹肝切除术(OLR)、腹腔镜肝切除术(LLR)和机器人辅助肝切除术(RLR)。排除有大血管侵犯、超过三个直径大于3 cm的转移灶或单个直径大于5 cm转移灶的患者,对任何剩余的异质性在倾向评分匹配(PSM)后进行进一步分析,以减少任何潜在偏差。(3) 结果:匹配前,566例患者因CRLM接受了OLR,462例接受了LLR,36例接受了RLR。PSM后,OLR与LLR组每组各有142例患者,OLR与RLR组有22例患者,LLR与RLR组有21例患者。与LLR组相比,OLR组的失血量、住院时间和发病率在统计学上均显著升高,分别为636 mL对353 mL、9天对5天、25%对6%(p < 0.001)。与OLR和LLR相比,RLR的失血量显著减少,分别为250 mL对597 mL和224 mL对778 mL,p分别< 0.008和p < 0.04。(4) 结论:SIMMILR表明,遵循米兰标准的CRLM微创治疗方法可能具有短期优势。值得注意的是,仍需要进行更大规模的长期随访研究,以比较机器人切除术与OLR和LLR的疗效。
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