同时性与分期性切除治疗结直肠肝转移同步性病变：赢率比方法。
Simultaneous versus staged resection for synchronous colorectal liver metastases: The win ratio approach.
机构信息
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA; Department of Surgery, University of Verona, Italy.
出版信息
Am J Surg. 2023 Mar;225(3):461-465. doi: 10.1016/j.amjsurg.2022.11.015. Epub 2022 Nov 19.
INTRODUCTION
In order to investigate the optimal approach for synchronous colorectal liver metastases (sCRLM), we sought to use the "win ratio" (WR), a novel statistical approach, to assess the relative benefit of simultaneous versus staged surgical treatment.
METHODS
Patients who underwent hepatectomy for sCRLM between 2008 and 2020 were identified from a multi-institutional database. The WR approach was utilized to compare composite outcomes of patients undergoing simultaneous versus staged resection.
RESULTS
Among 1116 patients, 642 (57.5%) presented with sCRLM; 290 (45.2%) underwent simultaneous resection, while 352 (54.8%) underwent staged resection. In assessing the composite outcome, staged resection yielded a WR of 1.59 (95%CI 1.47-1.71) over the simultaneous approach for sCRLM. The highest WR occurred among patients requiring major hepatectomy (WR = 1.93, 95%CI 1.77-2.10) compared with patients who required minor liver resection (WR = 1.55, 95%CI 1.44-1.70).
CONCLUSIONS
Staged resection was superior to simultaneous resection for sCRLM based on a WR assessment.
简介
为了探究同步结直肠肝转移（sCRLM）的最佳治疗方法，我们采用了一种新的统计学方法——“赢率”（WR），来评估同期与分期手术治疗的相对获益。
方法
从一个多机构数据库中确定了 2008 年至 2020 年间接受肝切除术治疗 sCRLM 的患者。采用 WR 方法比较同期与分期切除患者的复合结局。
结果
在 1116 例患者中，642 例（57.5%）患有 sCRLM；290 例（45.2%）接受同期切除术，352 例（54.8%）接受分期切除术。在评估复合结局时，分期切除术的 WR 为 1.59（95%CI 1.47-1.71），优于同期切除术。在需要进行大肝切除术的患者中，WR 最高（WR=1.93，95%CI 1.77-2.10），而在需要进行小肝切除术的患者中，WR 为 1.55（95%CI 1.44-1.70）。
结论
基于 WR 评估，分期切除术优于同期切除术治疗 sCRLM。
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