Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain.
Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain.
Cir Esp (Engl Ed). 2023 May;101(5):341-349. doi: 10.1016/j.cireng.2022.06.011. Epub 2022 Jun 3.
The "liver-first" approach (LFA) is a strategy indicated for advanced synchronous liver metastases (ASLM) from colorectal cancer (CRC). Includes neoadjuvant chemotherapy, resection of the ASLM followed by CRC resection.
Retrospective descriptive analysis from a prospective database of hepatectomies from liver metastases (LM) from CRC in two centers. Between 2007-2019, 88 patients with CRC-ASLM were included in a LFA scheme. Bilobar (LM) was present in 65.9%, the mean number of lesions was 5.5 and mean size 42.7 mm. Response to treatment was assessed by RECIST criteria. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier survival curves.
Seventy-five of 88 patients (85.2%) completed the LFA. RECIST evaluation showed partial response in 75.7% and stable disease in 22.8%. Severe morbidity rate (Clavien-Dindo ≥ IIIA) after liver and colorectal surgery was present in 29.4% and 9.3%, respectively. There was no 90-day postoperative mortality in both liver and colorectal surgeries. Recurrence rate was 76%, being the liver the most frequent site, followed by the pulmonary. From the total number of recurrences (106) in 56 patients, surgical with chemotherapy rescue treatment was accomplished in 34 of them (32.1%). The mean PFS was 8.5 and 5-year OS was 53%.
In patients with CRC-ASLM the LFA allows control of the liver disease beforehand and an assessment of the tumor response to neoadjuvant chemotherapy, optimising the chance of potentially curative liver resection, which influences long-term survival.
“肝优先”策略（LFA）是一种用于治疗结直肠癌（CRC）合并同步进展性肝转移（ASLM）的策略。该策略包括新辅助化疗、切除 ASLM 后再切除 CRC。
本研究回顾性分析了两个中心前瞻性数据库中接受肝切除术治疗 CRC 肝转移（LM）的患者资料。2007 年至 2019 年，共有 88 例 CRC-ASLM 患者纳入 LFA 方案。其中 65.9%的患者为双侧（LM）转移，转移灶的平均数量为 5.5 个，平均大小为 42.7mm。根据 RECIST 标准评估治疗反应。采用 Kaplan-Meier 生存曲线估计无进展生存期（PFS）和总生存期（OS）。
88 例患者中有 75 例（85.2%）完成了 LFA。RECIST 评估显示部分缓解率为 75.7%，稳定疾病率为 22.8%。肝脏和结直肠手术后严重并发症发生率（Clavien-Dindo≥IIIA）分别为 29.4%和 9.3%。两组患者均无 90 天术后死亡。复发率为 76%，肝转移是最常见的复发部位，其次是肺转移。在 56 例患者的 106 次复发中，34 例（32.1%）患者接受了化疗挽救治疗。中位 PFS 为 8.5 个月，5 年 OS 为 53%。
对于 CRC-ASLM 患者，LFA 可预先控制肝脏疾病，并评估肿瘤对新辅助化疗的反应，从而优化潜在根治性肝切除术的机会，这会影响患者的长期生存。
