Choong Kevin, Wong Paul, Thornblade Lucas, Melstrom Kurt, Lai Lily, Kaiser Andreas, Singh Gagandeep, Warner Susanne G, Fakih Marwan, Fong Yuman, Melstrom Laleh G
Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California.
Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California.
J Surg Res. 2023 Aug;288:252-260. doi: 10.1016/j.jss.2023.03.008. Epub 2023 Apr 6.
Existing literature on the safety of combined liver and colorectal resections for synchronous colorectal liver metastases is mixed. Using a retrospective review of our institutional data, we aimed to show that combined colorectal and liver resections for synchronous metastases is both feasible and safe in a quaternary center.
A retrospective review of combined resections for synchronous colorectal liver metastases at a quaternary referral center from 2015 to 2020 was completed. Clinicopathologic and perioperative data was collected. Univariate and multivariable analyses were performed to identify risk factors for major postoperative complications.
One hundred one patients were identified, with 35 undergoing major liver resections ( ≥ 3 segments) and 66 undergoing minor liver resections. The vast majority of patients (94%) received neoadjuvant therapy. There was no difference in postoperative major complications (Clavien-Dindo grade 3+) between major and minor liver resections (23.9% versus 12.1%, P = 0.16). On univariate analysis, Albumin-Bilirubin (ALBI) score >1 (P < 0.05) was predictive of major complication. However, on multivariable regression analysis, no factor was associated with significantly increased odds of major complication.
This work demonstrates that with thoughtful patient selection, combined resection for synchronous colorectal liver metastases can be safely performed at a quaternary referral center.
关于同期结直肠癌肝转移行肝切除联合结直肠癌切除安全性的现有文献结论不一。通过回顾我们机构的数据，我们旨在表明，在四级医疗中心，同期转移灶行结直肠癌和肝联合切除是可行且安全的。
完成了对一家四级转诊中心2015年至2020年同期结直肠癌肝转移联合切除术的回顾性研究。收集了临床病理和围手术期数据。进行单因素和多因素分析以确定术后主要并发症的危险因素。
共确定101例患者，其中35例行大肝切除（≥3个肝段），66例行小肝切除。绝大多数患者（94%）接受了新辅助治疗。大肝切除和小肝切除术后主要并发症（Clavien-Dindo 3级及以上）发生率无差异（23.9%对12.1%，P = 0.16）。单因素分析显示，白蛋白-胆红素（ALBI）评分>1（P < 0.05）可预测主要并发症。然而，多因素回归分析显示，没有因素与主要并发症发生几率显著增加相关。
这项研究表明，经过审慎的患者选择，在四级转诊中心可以安全地进行同期结直肠癌肝转移联合切除术。
