Department of Surgery, Medical Research Institute, Kitano Hospital, Osaka, Japan; Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: https://twitter.com/bosesurg0312.
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Surgery. 2022 Oct;172(4):1133-1140. doi: 10.1016/j.surg.2022.05.014. Epub 2022 Aug 12.
Liver resection is a standard therapy for colorectal liver metastasis. However, the impact of anatomical resection and nonanatomical resection on the survival in patients with Kirsten rat sarcoma-wild-type and Kirsten rat sarcoma-mutated colorectal liver metastasis remain unclear. We investigated whether anatomical resection versus nonanatomical resection improves survival in colorectal liver metastasis stratified by Kirsten rat sarcoma mutational status.
Among 639 consecutive patients with colorectal liver metastasis who underwent primary liver resection between January 2008 and December 2017, 349 patients were excluded due to their unknown Kirsten rat sarcoma mutational status, or due to receiving anatomical resection with concomitant non-anatomical resection, radiofrequency, or R2 resection. Accordingly, 290 patients with colorectal liver metastasis were retrospectively assessed. The relationships between resection types and survival were investigated in Kirsten rat sarcoma-wild-type and -mutated groups.
Anatomical resection was performed in 77/186 (41%) and 44/104 (42%) patients with Kirsten rat sarcoma-wild-type and Kirsten rat sarcoma-mutated genetic statuses, respectively. For both, the clinical-pathologic factors were comparable, except a larger maximum tumor size and surgical margin were observed in anatomical resection cases. Anatomical resection patients had significantly longer recurrence-free survival and overall survival than nonanatomical resection cases in the Kirsten rat sarcoma-wild-type group (recurrence-free survival, P < .001; overall survival, P = .005). No significant recurrence-free survival or overall survival differences were observed between Kirsten rat sarcoma-mutated anatomical resection and non-anatomical resection (recurrence-free survival, P = .132; overall survival, P = .563). Although, intrahepatic recurrence in Kirsten rat sarcoma-wild-type and -mutated colorectal liver metastasis was comparable (P = .973), extrahepatic recurrence was increased in Kirsten rat sarcoma-mutated versus -wild-type colorectal liver metastasis (P < .001).
In contrast to Kirsten rat sarcoma-mutated colorectal liver metastasis with higher extrahepatic recurrence after liver resection, local liver control via anatomical resection improved the postoperative survival in patients with Kirsten rat sarcoma-wild-type colorectal liver metastasis.
肝切除术是结直肠肝转移的标准治疗方法。然而，对于 KRAS 野生型和 KRAS 突变型结直肠肝转移患者，解剖性肝切除和非解剖性肝切除对生存的影响尚不清楚。我们研究了在 KRAS 突变状态分层的情况下，解剖性肝切除与非解剖性肝切除是否能改善结直肠肝转移患者的生存。
在 2008 年 1 月至 2017 年 12 月期间接受原发性肝切除术的 639 例连续结直肠肝转移患者中，由于 KRAS 突变状态未知，或由于接受解剖性肝切除合并非解剖性肝切除、射频或 R2 切除，349 例患者被排除在外。因此，回顾性评估了 290 例结直肠肝转移患者。在 KRAS 野生型和突变型组中，研究了切除类型与生存的关系。
KRAS 野生型和 KRAS 突变型患者分别有 77/186（41%）和 44/104（42%）行解剖性肝切除。除解剖性肝切除病例的最大肿瘤直径和手术切缘较大外，两组的临床病理因素相当。KRAS 野生型组中，解剖性肝切除患者的无复发生存率和总生存率明显长于非解剖性肝切除患者（无复发生存率，P <.001；总生存率，P=.005）。KRAS 突变型的解剖性肝切除与非解剖性肝切除之间无显著的无复发生存率或总生存率差异（无复发生存率，P=.132；总生存率，P=.563）。尽管 KRAS 野生型和突变型结直肠肝转移的肝内复发相似（P=.973），但 KRAS 突变型结直肠肝转移的肝外复发增加（P <.001）。
与 KRAS 突变型结直肠肝转移术后肝外复发率较高相比，通过解剖性肝切除控制局部肝转移可改善 KRAS 野生型结直肠肝转移患者的术后生存。
