Hepatopancreatobiliary Surgery Department I, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Haidian District, Beijing, China.
Updates Surg. 2022 Oct;74(5):1601-1610. doi: 10.1007/s13304-022-01312-7. Epub 2022 Jul 20.
The aim was to identify the optimal criteria of postoperative complications (POCs) for predicting oncological outcomes after hepatectomy for colorectal liver metastases (CRLMs) and to investigate the variable prognostic implications of POCs according to the modified clinical score (M-CS). We identified 751 patients who underwent curative hepatic resection for CRLM between 2007 and 2018. Patients were categorized based on the M-CS. The impact of the severity [≥ Clavien-Dindo grade (C-D) III or comprehensive complication index (CCI) ≥ 26.2] or type [any infectious complications of POC (Inf-poc)] of POC on overall survival (OS) and recurrence-free survival (RFS) was assessed by univariate and multivariable analyses in different groups. Patients with a major or infectious complication were not associated with either RFS or OS in multivariable analysis of the whole cohort. However, patients with a high CCI had a worse OS (HR 1.51, P = 0.004). Among patients with low M-CS, patients with high CCI had worse OS (HR 1.49, P = 0.035) and RFS (HR 1.32, P = 0.048) than those without high CCI. In contrast, the survival disadvantage of a high CCI was not present in patients with a high M-CS. Compared to Inf-poc or major complications, a high CCI decreased long-term OS in patients treated with hepatectomy for CRLM. High CCI has a variable prognostic impact after hepatic resection for CRLM depending on the M-CS. POC is not a decisive factor to justify the use of hepatectomy for CRLM in patients with high M-CS.
目的是确定术后并发症（POC）的最佳标准，以预测结直肠癌肝转移（CRLM）患者肝切除术后的肿瘤学结局，并根据改良临床评分（M-CS）研究 POC 的可变预后意义。我们确定了 2007 年至 2018 年间接受根治性肝切除术治疗 CRLM 的 751 例患者。患者根据 M-CS 进行分类。通过单变量和多变量分析评估 POC 的严重程度[≥Clavien-Dindo 分级（C-D）III 级或综合并发症指数（CCI）≥26.2]或类型[任何 POC 的感染性并发症（Inf-poc）]对总生存期（OS）和无复发生存期（RFS）的影响，不同组间。在整个队列的多变量分析中，主要或感染性并发症患者与 RFS 或 OS 均无相关性。然而，CCI 较高的患者 OS 较差（HR 1.51，P=0.004）。在 M-CS 较低的患者中，CCI 较高的患者 OS（HR 1.49，P=0.035）和 RFS（HR 1.32，P=0.048）较差，而 CCI 较低的患者则无差异。相反，CCI 较高的患者在 M-CS 较高的患者中并未出现生存劣势。与 Inf-poc 或主要并发症相比，CCI 较高会降低接受肝切除术治疗 CRLM 患者的长期 OS。CCI 对 CRLM 肝切除术后的预后有不同的影响，取决于 M-CS。POC 不是决定是否在 M-CS 较高的患者中进行肝切除术治疗 CRLM 的决定性因素。
