Lünse Sebastian, von Ruesten Anne, Schneider Constanze, Gretschel Stephan, Loew Andreas, Mantke René
Department of General and Visceral Surgery, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Hochstrasse 29, 14770, Brandenburg/Havel, Germany.
Clinical-Epidemiological Cancer Registry Brandenburg Berlin, Dreifertstrasse 12, 03044, Cottbus, Germany.
Langenbecks Arch Surg. 2025 Aug 28;410(1):253. doi: 10.1007/s00423-025-03840-3.
Colorectal cancer is the third most common cancer worldwide, with 15-25% of patients presenting synchronous liver metastases (UICC stage IV). Surgical resection remains crucial, but the optimal sequence for managing synchronous metastases is debated. This study evaluates the impact of different surgical strategies on survival in colorectal cancer patients with liver-only metastases (CRLM) and identifies factors influencing mortality.
This retrospective cohort study analyzed CRLM patients from German cancer registries in Brandenburg and Berlin from 2017 to 2022, grouped by surgical treatment sequence: simultaneous primary tumor resection (PTR) and liver resection, PTR before liver resection, or liver resection before PTR. Kaplan-Meier and Cox regression analyses evaluated overall survival (OS) and the impact of systemic therapy and patient characteristics.
Among 23,394 colorectal cancer patients, 209 met inclusion criteria. Simultaneous resection was performed in 45% (N = 93), PTR before liver resection in 43% (N = 90), and liver resection first in 12% (N = 26). PTR before liver resection showed the best 5-year OS (68% vs. 53% for simultaneous surgery; HR 0.44, 95% CI = 0.22-0.88, p = 0.020). Simultaneous resection had the highest 30-day mortality (6.5%, N = 6). Postoperative chemotherapy significantly improved 5-year OS (66% vs. 57% for no chemotherapy; HR 0.45, 95% CI = 0.22-0.95, p = 0.036). Excluding 30-day mortality, survival differences diminished.
Primary tumor resection before liver resection appears to improve long-term survival in CRLM patients. Simultaneous resection should be carefully considered due to increased mortality, particularly in older patients with lower performance status undergoing major liver surgery. Postoperative chemotherapy enhances survival, emphasizing the need for tailored treatment strategies.
结直肠癌是全球第三大常见癌症，15% - 25%的患者会出现同时性肝转移（国际抗癌联盟IV期）。手术切除仍然至关重要，但对于同时性转移的最佳治疗顺序存在争议。本研究评估了不同手术策略对仅发生肝转移的结直肠癌患者（CRLM）生存的影响，并确定影响死亡率的因素。
这项回顾性队列研究分析了2017年至2022年来自勃兰登堡和柏林德国癌症登记处的CRLM患者，按手术治疗顺序分组：同时进行原发肿瘤切除（PTR）和肝切除、肝切除前进行PTR或肝切除前进行PTR。Kaplan - Meier和Cox回归分析评估总生存期（OS）以及全身治疗和患者特征的影响。
在23394例结直肠癌患者中，209例符合纳入标准。45%（N = 93）进行了同时切除，43%（N = 90）在肝切除前进行了PTR，12%（N = 26）先进行了肝切除。肝切除前进行PTR显示出最佳的5年总生存期（同时手术为68%对53%；风险比0.44，95%置信区间 = 0.22 - 0.88，p = 0.020）。同时切除的30天死亡率最高（6.5%，N = 6）。术后化疗显著提高了5年总生存期（未化疗为66%对57%；风险比0.45，95%置信区间 = 0.22 - 0.95，p = 0.036）。排除30天死亡率后，生存差异减小。
肝切除前进行原发肿瘤切除似乎可提高CRLM患者的长期生存率。由于死亡率增加，应谨慎考虑同时切除，特别是对于身体状况较差的老年患者进行大型肝手术时。术后化疗可提高生存率，强调了制定个性化治疗策略的必要性。
