Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan.
Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
World J Surg. 2022 Sep;46(9):2253-2261. doi: 10.1007/s00268-022-06616-8. Epub 2022 Jun 12.
Although surgical resection is the only potential treatment for patients with colorectal liver metastases (CLM), the actual cure is rare in patients with advanced CLM. Repeat resection (RR) is the most effective treatment in patients with recurrence; however, whether patients with initially advanced CLM achieve cure throughout RR or experience repeated recurrence even after RR remains unclear. In this study, we analyzed whether patients with advanced CLM achieve cure after RR.
Consecutive patients who underwent initial hepatectomy with curative intent for CLM from January 1999 to August 2007 were included. Patients who were alive at 10 years from the initial hepatectomy without any evidence of recurrence were defined as cured. Cure rates were compared between patients with Fong's clinical risk score (CRS) of ≥ 3 and those with CRS of ≤ 2.
A total of 257 patients were included and followed up. Among them, 93 (36.2%) patients achieved actual cure postoperatively. The cure rate of patients with a CRS of ≥ 3 was 32.4% (33/102), which was not different from that of patients with a CRS of ≤ 2 (38.7% [60/155]; p = 0.299), although former patients had higher recurrence rate after the initial hepatectomy than latter ones (85.3% vs. 72.3%; p = 0.014). The cure rates after the initial, second, and third resections were 23.0% (59/257), 30.0% (24/80), and 22.5% (7/31), respectively. In multivariate analysis, RR was determined as an independent favorable factor of achieving cure.
RR had a potential to cure patients with advanced CLM, and one-third of them achieved cure.
虽然手术切除是结直肠癌肝转移（CLM）患者唯一潜在的治疗方法，但对于晚期 CLM 患者，实际治愈的情况很少见。复发后再次切除（RR）是复发患者最有效的治疗方法；然而，最初患有晚期 CLM 的患者通过 RR 治愈，还是即使在 RR 后仍反复复发，目前尚不清楚。在这项研究中，我们分析了 RR 后晚期 CLM 患者是否能治愈。
本研究纳入了 1999 年 1 月至 2007 年 8 月期间首次接受根治性肝切除术治疗 CLM 的连续患者。从首次肝切除开始 10 年时仍存活且无任何复发迹象的患者被定义为治愈。比较了 Fong 临床风险评分（CRS）≥3 和 CRS≤2 的患者之间的治愈率。
共纳入并随访了 257 例患者。其中，93 例（36.2%）患者术后获得实际治愈。CRS≥3 的患者治愈率为 32.4%（33/102），与 CRS≤2 的患者（38.7%[60/155]；p=0.299）无差异，尽管前者在初始肝切除术后的复发率高于后者（85.3%比 72.3%；p=0.014）。首次、二次和三次切除后的治愈率分别为 23.0%（59/257）、30.0%（24/80）和 22.5%（7/31）。多变量分析表明，RR 是实现治愈的独立有利因素。
RR 有可能治愈晚期 CLM 患者，其中三分之一的患者达到治愈。
