诊断为结直肠癌的患者中有50%发生结直肠肝转移。结直肠肝转移的手术切除通常涉及解剖切除(AR)或保留实质的肝切除术(PSH)。当前研究的目的是分析CLM的实质与非实质保留肝切除术的数据。
对保留肝实质切除术的文献进行了系统综述。MEDLINE/PubMed,科克伦,和EMBASE数据库搜索包含以下医学主题词(MeSH)的出版物:“结直肠肿瘤,\“\”肿瘤转移,\"\"肝肿瘤\"和\"肝切除术\"。此外,以下关键词用于完成文献检索:“肝切除术,“\”肝切除术,\"\"肝切除,\"\"解剖/解剖学,\"\"非解剖/非解剖,\"\"少校,\"\"未成年人,\"\"有限,\"\"楔形,\"\"CRLM/CLM,“和”结直肠癌肝转移。\"数据被审查,聚合,并分析。
在12项研究中纳入了接受PSH(n=1087例患者)或AR(n=1418例患者)的2500例患者。大多数患者的原发性肿瘤起源于结肠(PSH52.2-74.4%vs.AR53.9-74.3%)(P=0.289)。大多数研究包括仅患有孤立性肿瘤的大部分患者,报告的中位肿瘤数为1-2,无论患者是否接受PSH或AR。对于CLM,接受PSH(100-896mL)和AR(200-1489mL)的患者的EBL中位数没有差异(P=0.248)。PSH(6-17天)和AR(7-15天)后的中位住院时间没有差异(P=0.747)。虽然在边缘状态方面存在相当大的研究间差异,在接受PSH(66.7-100%)和AR(71.6-98.6%)的患者中,R0切除的发生率没有差异(P=0.58).在评估总生存率时,是否采用PSH进行CLM切除没有差异(5年OS:平均44.7%,范围29-62%)或AR(5年OS:平均44.6%,范围27-64%)(P=0.97)。
与AR相比,PSH具有相当的安全性和有效性,并且不影响肿瘤学结局。PSH应被视为CLM患者的适当手术治疗方法,以促进肝实质的保存。
Colorectal liver metastases develop in 50% of patients diagnosed with colorectal cancer. Surgical resection for colorectal liver metastasis typically involves either anatomical resection (AR) or parenchymal-sparing hepatectomy (PSH). The objective of the current study was to analyze data on parenchymal versus non-parenchymal-sparing hepatic resections for CLM.
A systematic review of the literature regarding parenchymal-sparing hepatectomy was performed. MEDLINE/PubMed, Cochrane, and EMBASE databases were searched for publications containing the following medical subject headings (MeSH): \"Colorectal Neoplasms,\" \"Neoplasm Metastasis,\" \"Liver Neoplasms\" and \"Hepatectomy\". Besides, the following keywords were used to complete the literature search: \"Hepatectomy,\" \"liver resection,\" \"hepatic resection,\" \"anatomic/anatomical,\" \"nonanatomic/ nonanatomical,\" \"major,\" \"minor,\" \"limited,\" \"wedge,\" \"CRLM/CLM,\" and \"colorectal liver metastasis.\" Data was reviewed, aggregated, and analyzed.
Two thousand five hundred five patients included in 12 studies who underwent either PSH (n = 1087 patients) or AR (n = 1418 patients) were identified. Most patients had a primary tumor that originated in the colon (PSH 52.2-74.4% vs. AR 53.9-74.3%) (P = 0.289). The majority of studies included a large subset of patients with only a solitary tumor with a reported median tumor number of 1-2 regardless of whether the patient underwent PSH or AR. Median EBL was no different among patients undergoing PSH (100-896 mL) versus AR (200-1489 mL) for CLM (P = 0.248). There was no difference in median length-of-stay following PSH (6-17 days) versus AR (7-15 days) (P = 0.747). While there was considerable inter-study variability regarding margin status, there was no difference in the incidence of R0 resection among patients undergoing PSH (66.7-100%) versus AR (71.6-98.6%) (P = 0.58). When assessing overall survival, there was no difference whether resection of CLM was performed with PSH (5 years OS: mean 44.7%, range 29-62%) or AR (5 years OS: mean 44.6%, range 27-64%) (P = 0.97).
PSH had a comparable safety and efficacy profile compared with AR and did not compromise oncologic outcomes. PSH should be considered an appropriate surgical approach to treatment for patients with CLM that facilitates preservation of hepatic parenchyma.