基于限制性肝段切除手术的局部治疗模式改善结直肠癌术后肝脏寡转移的预后分析

李江; 候宇; 蔡晓蓓; 徐承雷; 易根发

doi:10.3969/j.issn.1001-5256.2020.08.017

基于限制性肝段切除手术的局部治疗模式改善结直肠癌术后肝脏寡转移的预后分析

DOI: 10.3969/j.issn.1001-5256.2020.08.017

1. 昆明医科大学第一附属医院肝胆外科
2. 昆明医科大学第三附属医院云南省肿瘤医院放疗科
3. 昆明医科大学第一附属医院介入科

详细信息

中图分类号: R735.34
计量
- 文章访问数: 1216
- HTML全文浏览量: 12
- PDF下载量: 186
- 被引次数: 0
出版历程
- 出版日期: 2020-08-20

Clinical effect of local treatment based on limited segmental resection in improving the prognosis of liver oligometastasis after surgery for colorectal cancer

The First Affiliated Hospital of Kunming Medical University

摘要

摘要:
目的探讨基于限制性肝段切除手术的局部治疗模式能否较其他非手术模式改善结直肠癌术后肝脏寡转移的预后及其个体化实施方案。方法收集2012年1月-2018年12月昆明医科大学第一附属医院结直肠癌根治术后肝脏寡转移局部治疗的74例患者的资料,根据治疗模式分为手术组（n=39）和非手术组（n=35）。比较2组患者的治疗方案及并发症。计量资料组间比较采用t检验或Mann-Whitney U检验;计数资料组间比较采用χ2检验或Fisher检验。采用Kaplan-Meier法绘制生存曲线,并计算中位无瘤生存时间（DFS）及总生存时间（OS）,log-rank检验进行生存分析。结果手术组39例患者中开腹23例,腹腔镜16例;术式为单纯限制性肝段/亚段切除11例,联合小病灶楔形切除21例,联合射频消融7例;术后并发症5例,其中出血1例,胆瘘1例,胸腔积液3例。非手术组35例中治疗方式包括超声或CT引导射频消融（RFA）联合经肝动脉化疗栓塞术（TACE） 18例,TACE5例,RFA 9例,立体定向体部放射治疗3例; TACE术后肝脓肿1例,RFA术后气胸1例。全部病例治疗后30 d后...
- 结直肠肿瘤 /
- 肿瘤转移 /
- 肝切除术 /
- 预后
Abstract:
Objective To investigate whether local treatment based on limited segmental resection can improve the prognosis of colorectal liver oligometastases(CRLOM) compared with other non-surgical treatment method,as well as the individualized regimen of this treatment method.Methods A retrospective analysis was performed for the clinical data of 74 CRLOM patients who underwent local treatment in The First Affiliated Hospital of Kunming Medical University from January 2012 to December 2018,and according to the treatment method,they were divided into surgical group with 39 patients and non-surgical group with 35 patients.Treatment regimen and complications were compared between the two groups.The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups;the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to plot survival curves and calculate median disease-free survival(DFS) time and overall survival(OS) time,and the log-rank test was used for survival analysis.Results Among the 39 patients in the surgical group,23 underwent laparotomy and 16 underwent laparoscopy;as for the surgical procedure,11 underwent limited segmental/subsegmental resection alone,21 underwent limited segmental/subsegmental resection combined with wedge resection of small lesions,and 7 underwent limited segmental/subsegmental resection combined with radiofrequency ablation(RFA);5 patients experienced postoperative complications,with bleeding in 1 patient,biliary fistula in 1 patient,and pleural effusion in 3 patients.Among the 35 patients in the non-surgical group,18 underwent ultrasound-or CT-guided RFA combined with transarterial chemoembolization(TACE),5 underwent TACE alone,9 underwent RFA,and 3 underwent stereotactic body radiotherapy;as for postoperative complications,1 patient experienced liver abscess after TACE,and 1 experienced pneumothorax after RFA.No patient died within 30 days after treatment.The surgical group had a DFS time of 38 months(95% confidence interval [CI]:31.3-44.9)and an OS time of 27 months(95% CI:19.9-34.0),and the non-surgical group had a DFS time of 64 months(95% CI:57.6-70.1)and an OS time of 43 months(95% CI:36.2-50.0),with significant differences between the two groups(χ2=6.072 and 11.685,P=0.014 and 0.001).The surgical group had a 1-year survival rate of 92.3% and a 5-year survival rate of 41.0%,while the non-surgical group had a 1-year survival rate of 82.8% and a 5-year survival rate of 14.3%.Conclusion Compared with non-local surgical treatment,local treatment based on limited segmental resection can significantly improve the prognosis of CRLOM in patients with colorectal cancer.The surgical procedure should be individualized according to lesion characteristics.
- colorectal neoplasms /
- neoplasm metastasis /
- hepatectomy /
- prognosis

HTML全文

参考文献(20)

[1] CREASY JM,SADOT E,KOERKAMP BG,et al. Actual 10-year survival after hepatic resection of colorectal liver metastases:What factors preclude cure?[J]. Surgery,2018,163(6):1238-1244.

[2] ZHANG ZQ. Analysis of prognostic factors for patients treated by radical resection of liver metastases from colorectal cancer[J]. J Clin Hepatol,2015,31(9):1455-1457.(in Chinese)张志泉．结直肠癌肝转移患者行肝根治性切除术的预后影响因素分析[J]．临床肝胆病杂志，2015,31(9):1455-1457.

[3] LIU X,LIU F,LIU YF,et al. Clinical effect of intraoperative laparotomic color Doppler ultrasound-guided radiofrequency versus percutaneous CT-guided radiofrequency in treatment of colorectal cancer liver metastasis[J]. Clin J Med Offic,2020,48(2):167-169.(in Chinese)刘信，刘放，刘也夫，等．术中开腹彩超引导下射频与经皮CT引导射频治疗结直肠癌肝转移疗效比较研究[J]．临床军医杂志，2020,48(2):167-169.

[4] IMAI K,ALLARD MA,BENITEZ CC,et al. Early recurrence after hepatectomy for colorectal liver metastases:What optimal definition and what predictive factors?[J]. Oncologist,2016,21(7):887-894.

[5] LI MJ,CHEN D,CHEN WB. Effects ofβ-adrenergic receptor blockers and COX-2 inhibitors on liver metastasis of colorectal cancer[J]. Chin J Clin Pharmacol Ther,2018,23(8):893-899.(in Chinese)李敏江，陈栋，陈文斌．β-肾上腺素能受体阻滞剂和COX-2抑制剂在结直肠癌肝转移中的作用研究[J]．中国临床药理学与治疗学，2018,23(8):893-899.

[6] DEXIANG Z,LI R,YE W,et al. Outcome of patients with colorectal liver metastasis:Analysis of 1613 consecutive cases[J]. Ann Surg Oncol,2012,19(9):2860-2868.

[7] BENSON AB,VENOOK AP,CEDERQUIST L,et al. Colon Cancer,Version 1,2017,NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw,2017,15(3):370-398.

[8] LORDAN JT,ROBERTS JK,HODSON J,et al. Case-controlled study comparing peri-operative and cancer-related outcomes after major hepatectomy and parenchymal sparing hepatectomy for metastatic colorectal cancer[J]. HPB(Oxford),2017,19(8):688-694.

[9] MISE Y,ALOIA TA,BRUDVIK KW,et al. Parenchymal-paring hepatectomy in colorectal liver metastasis improves salvageability and survival[J]. Ann Surg,2016,263(1):146-152.

[10] MEMEO R,de BLASI V,ADAM R,et al. Parenchymal-sparing hepatectomies(PSH)for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results:A propensity score matching analysis[J]. HPB(Oxford),2016,18(9):781-790.

[11] IMAI K,ALLARD MA,CASTRO BC,et al. Nomogram for prediction of prognosis in patients with initially unresectable colorectal liver metastasis[J]. Br J Surg,2016,103(5):590-599.

[12] BRUDVIK KW,JONES RP,GIULIANTE F,et al. RAS mutation clinical risk score to predict survival after resection of colorectal liver metastases[J]. Ann Surg,2019,269(1):120-126.

[13] MARGONIS GA,SASAKI K,GHOLAMI S,et al. Genetic and Morphological Evaluation(GAME)score for patients with colorectal liver metastases[J]. Br J Surg,2018,105(9):1210-1220.

[14] van CUTSEM E,CERVANTES A,ADAM R,et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer[J]. Ann Oncol,2016,27(8):1386-1422.

[15] MATSUKI R,MISE Y,SAIURA A,et al. Parenchymal-sparing hepatectomy for deep-placed colorectal liver metastases[J]. Surgery,2016,160(5):1256-1263.

[16] TORZILLI G,ADAM R,VIGANL,et al. Surgery of colorectal liver metastases:Pushing the limits[J]. Liver Cancer,2016,6(1):80-89.

[17] VIGANL,PROCOPIO F,CIMINO MM,et al. Is tumor detachment from vascular structures equivalent to R0 resection in surgery for colorectal liver metastases? An observational cohort[J]. Ann Surg Oncol,2016,23(4):1352-1360.

[18] URBANI L,COLOMBATTO P,BALESTRI R,et al. Techniques of parenchyma-sparing hepatectomy for the treatment of tumors involving the hepatocaval confluence:A reliable way to assure an adequate future liver remnant volume[J]. Surgery,2017,162(3):483-499.

[19] SASAKI K,MARGONIS GA,MAITANI K,et al. The prognostic impact of determining resection margin status for multiple colorectal metastases according to the margin of the largest lesion[J]. Ann Surg Oncol,2017,24(9):2438-2446.

[20] DING XY,CHEN JL,SUN W,et al. Influence of time schedule of radiofrequency ablation on the safety and prognosis of patients with colorectal cancer liver metastasis receiving XELOX regimen:A single-center clinical study[J]. J Clin Hepatol,2018,34(12):2603-2609.(in Chinese)．丁晓燕，陈京龙，孙巍，等．射频消融先后顺序对XELOX方案治疗结直肠癌肝转移患者安全性和预后的影响[J]．临床肝胆病杂志，2018,33(12):2603-2609.

施引文献

资源附件(0)

访问统计