Fukata Koji, Fukunaga Yosuke, Hiyoshi Yukiharu, Mukai Toshiki, Yamaguchi Tomohiro, Nagasaki Toshiya, Nagayama Satoshi, Akiyoshi Takashi
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
J Anus Rectum Colon. 2024 Oct 25;8(4):365-374. doi: 10.23922/jarc.2023-071. eCollection 2024.
Peritoneal metastasis indicates a poor prognosis in patients with colorectal cancer (CRC). Studies have shown improved prognosis in patients after removal of peritoneal dissemination, and this surgery is recommended if not excessively invasive. The aim of this study was to examine clinical outcomes and prognostic factors for R0 resected CRC with synchronous peritoneal metastasis.
We analyzed data retrospectively from 250 patients with stage IV CRC who underwent R0 resection at our hospital. The patients were divided into three groups according to the type of surgery: non-resected (N), palliative primary tumor resection (P), and R0 resection (R0) groups. Overall survival (OS) and recurrence-free survival (RFS) were investigated and clinicopathological parameters were analyzed for prognostic significance.
The 3-year OS was 57.2% in the R0 group. The R0 group had a significantly higher 3-year OS than that in the other groups (p < 0.0001). Multivariate analysis revealed that histological type, lymphatic and venous invasion, liver metastasis, R0 resection, and perioperative chemotherapy were independent prognostic factors. The 5-year RFS in the R0 group was 26.5%. Multivariate analysis revealed that the number of peritoneal metastases and surgical procedure were independent prognostic factors. Laparoscopic surgery had better 5-year RFS in the R0 group compared with that in the open surgery group (p = 0.0044).
R0 resection of colorectal cancer with synchronous peritoneal metastasis should be considered for improving long-term survival. The laparoscopic approach for this disease is another promising method to prolong survival in patients with R0 resection.
腹膜转移提示结直肠癌（CRC）患者预后不良。研究表明，切除腹膜转移灶后患者预后改善，若手术侵袭性不过高，则推荐进行该手术。本研究旨在探讨R0切除的同步腹膜转移CRC患者的临床结局和预后因素。
我们回顾性分析了我院250例接受R0切除的IV期CRC患者的数据。根据手术类型将患者分为三组：未切除组（N）、姑息性原发肿瘤切除组（P）和R0切除组（R0）。研究总生存期（OS）和无复发生存期（RFS），并分析临床病理参数的预后意义。
R0组的3年总生存率为57.2%。R0组的3年总生存率显著高于其他组（p<0.0001）。多因素分析显示，组织学类型、淋巴和静脉侵犯、肝转移、R0切除和围手术期化疗是独立的预后因素。R0组的5年无复发生存率为26.5%。多因素分析显示，腹膜转移灶数量和手术方式是独立的预后因素。与开放手术组相比，R0组腹腔镜手术的5年无复发生存率更高（p = 0.0044）。
对于同步腹膜转移的结直肠癌，应考虑行R0切除以提高长期生存率。对于该病，腹腔镜手术方式是延长R0切除患者生存期的另一种有前景的方法。
