Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
World J Surg Oncol. 2023 Sep 1;21(1):276. doi: 10.1186/s12957-023-03162-y.
The optimal timing of surgery after neoadjuvant chemotherapy (NAC) in patients with synchronous colorectal cancer liver metastases (SLM) remains controversial. We plan to analyze whether the choice of different surgical timings will have different effects on the perioperative and oncologic outcomes of patients.
We retrospectively collected all patients who met the inclusion and exclusion criteria from 2010 to 2020 in West China Hospital. Patients were grouped according to time interval (TI) after NAC to surgery. The perioperative and oncologic outcomes of the two groups were compared after propensity score matching. Univariate and multivariate analyzes were used to screen factors associated with prognosis.
Among 255 enrolled patients, 188 were matched with comparable baseline (94 each group). Patients in the 6≦TI≦8 group had longer operation time, less intraoperative blood loss, and less postoperative complications than those in the 4≦TI < 6 group. However, the overall survival (OS) (p = 0.012) and disease-free survival (DFS) (p = 0.013) of the patients in the 4≦TI < 6 group were better than those in the 6≦TI≦8 group. Subgroup analysis found that the above conclusions still apply in age ≥ 60, non-anemic patients, and patients who underwent R0 resection. OS was inversely correlated with TI in patients without preoperative jaundice. DFS was negatively correlated with TI in patients with preoperative jaundice. Multivariate analysis showed that the prolongation of TI after NAC to surgery was an independent prognostic risk factor for OS and DFS.
Patients with SLM may be a better choice for surgery within 4-6 weeks after receiving NAC. Although patients with SLM undergoing surgery 4-6 weeks after NAC has a higher rate of postoperative complications, radical surgery is still recommended for a better survival benefit.
新辅助化疗（NAC）后同步结直肠癌肝转移（SLM）患者的手术时机仍存在争议。我们计划分析不同手术时机的选择是否会对患者的围手术期和肿瘤学结果产生不同的影响。
我们回顾性地从 2010 年至 2020 年在华西医院收集符合纳入和排除标准的所有患者。根据 NAC 后手术的时间间隔（TI）将患者分组。在倾向评分匹配后比较两组的围手术期和肿瘤学结果。使用单因素和多因素分析筛选与预后相关的因素。
在 255 名入组患者中，有 188 名患者与可比基线相匹配（每组 94 名）。TI 为 6≦TI≦8 组的患者手术时间较长，术中出血量较少，术后并发症较少，但 4≦TI<6 组的患者总生存期（OS）（p=0.012）和无病生存期（DFS）（p=0.013）更好。亚组分析发现，在年龄≥60 岁、非贫血患者和接受 R0 切除的患者中，上述结论仍然适用。OS 与 TI 呈负相关，在无术前黄疸的患者中。DFS 与 TI 呈负相关，在术前有黄疸的患者中。多因素分析显示，NAC 后手术 TI 的延长是 OS 和 DFS 的独立预后危险因素。
接受 NAC 后 4-6 周内接受手术的 SLM 患者可能是更好的选择。尽管接受 NAC 后 4-6 周接受手术的 SLM 患者术后并发症发生率较高，但仍推荐进行根治性手术以获得更好的生存获益。
