Mahamid Ahmad, Abu-Zaydeh Omar, Mattar Samar, Kazlow Esther, Froylich Dvir, Sawaied Muneer, Goldberg Natalia, Berger Yael, Sadot Eran, Haddad Riad
Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel.
The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel.
J Clin Med. 2023 Jul 20;12(14):4785. doi: 10.3390/jcm12144785.
(1) Background: Hand-assisted laparoscopic surgery (HALS) has engendered growing attention as a safe procedure for the resection of metastatic liver disease. However, there is little data available regarding the outcomes of HALS for colorectal liver metastasis (CRLM) in patients over the age of 75. (2) Methods: We compare the short- and long-term outcomes of patients >75-years-old (defined in our study as "elderly patients" and referred to as group 1, G1), with patients <75-years-old (defined in our study as "younger patients" and referred to as group 2, G2). (3) Results: Of 145 patients, 28 were in G1 and 117 were in G2. The most common site of the primary tumor was the right colon in G1, and the left colon in G2 ( = 0.05). More patients in G1 underwent laparoscopic anterior segment resection compared with G2 (43% vs. 39% respectively) ( = 0.003). 53% of patients in G1 and 74% of patients in G2 completed neoadjuvant therapy ( = 0.04). The median size of the largest metastasis was 32 (IQR 19-52) mm in G1 and 20 (IQR 13-35) mm in G2 ( = 0.001). The rate of complications (Dindo-Clavien grade ≥ III) was slightly higher in G1 ( = 0.06). The overall 5-year survival was 30% in G1 and 52% in G2 ( = 0.12). (4) Conclusions: Hand-assisted laparoscopic surgery for colorectal liver metastasis is safe and effective in an elderly patient population.
(1) 背景：手辅助腹腔镜手术（HALS）作为一种安全的转移性肝病切除手术，已引起越来越多的关注。然而，关于75岁以上患者结直肠癌肝转移（CRLM）的HALS手术结果，现有数据很少。(2) 方法：我们比较了年龄大于75岁（在本研究中定义为“老年患者”，称为第1组，G1）和年龄小于75岁（在本研究中定义为“年轻患者”，称为第2组，G2）患者的短期和长期结果。(3) 结果：145例患者中，28例在G1组，117例在G2组。G1组原发性肿瘤最常见部位是右半结肠，G2组是左半结肠（P = 0.05）。与G2组相比，G1组更多患者接受了腹腔镜前段切除术（分别为43%对39%）（P = 0.003）。G1组53%的患者和G2组74%的患者完成了新辅助治疗（P = 0.04）。G1组最大转移灶的中位大小为32（四分位间距19 - 52）mm，G2组为20（四分位间距13 - 35）mm（P = 0.001）。G1组并发症发生率（Dindo-Clavien分级≥III级）略高（P = 0.06）。G1组总体5年生存率为30%，G2组为52%（P = 0.12）。(4) 结论：手辅助腹腔镜手术治疗结直肠癌肝转移在老年患者群体中是安全有效的。
