Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA.
Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, 00168, Italy.
J Gastrointest Surg. 2022 Dec;26(12):2503-2511. doi: 10.1007/s11605-022-05456-0. Epub 2022 Sep 20.
Recurrence after curative hepatectomy for colorectal liver metastases (CRLM) is common. We sought to determine if number and sites of resections of recurrence after hepatectomy for CRLM impact survival.
The study included patients who underwent resection of recurrence following complete curative-intent resection of CRLM during 1998-2016 at two academic medical centers in Houston, USA, and Rome, Italy. The survival impacts of number and sites of resections of recurrence were evaluated. Patients with synchronous extrahepatic disease at curative CRLM resection were excluded.
Among 2163 patients who underwent curative hepatectomy, 1456 (67.3%) developed a recurrence. Four hundred seventy-eight patients underwent one (322/478; 67.4%) or two or more (156/478; 32.6%) resections of recurrence. The 5-year overall survival (OS) rate was higher in patients with resected than unresected recurrence (70.2% vs. 24.0%; p < 0.001). In patients who underwent only one resection of recurrence, the 5-year OS rate differed by location (lung, 81.6%; liver, 64.3%; other, 54.1%). In patients who underwent two or more resections of recurrence, the 5-year OS rate was similar for liver-only resection (87.5%) and resection of liver and other sites (66.1%) (p = 0.223) and for liver-only resection and other-sites-only resection (80.7%) (p = 0.258); 5-year OS rate by site of first resection of recurrence did not differ between liver (78.5%) and lung (81.8%) (p = 0.502) but was worse for other sites (61.1%) than for lung (p = 0.045).
When recurrence after initial CRLM resection is resectable, the ability to undergo resection was associated with improved survival and can be considered as an option regardless of the number of recurrence and resection. Sites of resection of recurrence impact survival and should be considered.
结直肠肝转移（CRLM）根治性肝切除术后复发较为常见。我们旨在明确肝切除术后复发灶的数目和部位是否影响生存。
本研究纳入了 1998 年至 2016 年期间，在美国休斯顿的两个学术医疗中心和意大利罗马的一家学术医疗中心接受了 CRLM 根治性切除术后复发灶切除术的患者。评估了复发灶切除的数目和部位对生存的影响。CRLM 根治性切除时合并同步肝外疾病的患者被排除在外。
在 2163 例行根治性肝切除术的患者中，1456 例（67.3%）发生了复发。478 例患者接受了一次（322/478；67.4%）或两次或以上（156/478；32.6%）的复发灶切除术。与未行切除术的复发患者相比，行切除术的患者的 5 年总生存率（OS）更高（70.2% vs. 24.0%；p<0.001）。在仅行一次复发灶切除术的患者中，复发灶的部位不同，5 年 OS 率也不同（肺，81.6%；肝，64.3%；其他部位，54.1%）。在接受两次或以上复发灶切除术的患者中，仅行肝切除术与肝和其他部位切除术（66.1%）（p=0.223）和仅行肝切除术与仅行其他部位切除术（80.7%）（p=0.258）的 5 年 OS 率相似；首次复发灶切除术的部位与首次肝切除术（78.5%）和肺切除术（81.8%）（p=0.502）的 5 年 OS 率无差异，但与其他部位切除术（61.1%）相比，肺切除术的 5 年 OS 率更差（p=0.045）。
在初始 CRLM 切除术后的复发灶可切除时，行切除术的能力与生存改善相关，无论复发灶的数目和切除部位如何，均可将其作为一种选择。复发灶的切除部位影响生存，应予以考虑。
