Simultaneous versus staged resection for synchronous colorectal liver metastases: A population-based cohort study

被引：35

作者：

Bogach, Jessica ^{[1
]}

Wang, Julian ^{[2
]}

Griffiths, Christopher ^{[3
]}

Parpia, Sameer ^{[4
,5
,6
]}

Saskin, Refik ^{[7
]}

Hallet, Julie ^{[1
,8
]}

Ruo, Leyo ^{[3
]}

Simunovic, Marko ^{[3
,4
,5
]}

Serrano, Pablo E. ^{[3
,6
]}

机构：

[1] Univ Toronto, Dept Surg, Toronto, ON, Canada

[2] McMaster Univ, Michael DeGroote Sch Med, Hamilton, ON, Canada

[3] McMaster Univ, Dept Surg, Hamilton, ON, Canada

[4] McMaster Univ, Dept Oncol, Hamilton, ON, Canada

[5] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[6] McMaster Univ, Ontario Clin Oncol Grp, Hamilton, ON, Canada

[7] McMaster Univ, Inst Clin Evaluat Sci, Hamilton, ON, Canada

[8] Sunnybrook Hlth Sci Ctr, Div Gen Surg, Odette Canc Ctr, Toronto, ON, Canada

来源：

INTERNATIONAL JOURNAL OF SURGERY | 2020年 / 74卷

关键词：

Colorectal cancer; Colorectal liver metastases; Synchronous metastases; Simultaneous resection; Population-based study; HEPATIC METASTASES; CANCER; CHEMOTHERAPY; MANAGEMENT; IMPACT; SAFE;

D O I：

10.1016/j.ijsu.2019.12.009

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: Synchronous liver metastases from colorectal cancer may be resected simultaneously with the primary or as a second staged operation. We evaluated trends of resection for synchronous colorectal cancer liver metastases and associated patient outcomes. Methods: This is a retrospective cohort study that included patients undergoing resection for synchronous colorectal cancer liver metastases from 2006 to 2015 in the province of Ontario, Canada (population 13 million). Simultaneous resections occurred on the same admission, while staged resections occurred less than 6 months apart. Outcomes included postoperative complications, length of hospital stay, and overall survival. Kaplan Meier survival estimates, Cox proportional hazard models and logistic regression were used. Results: Among 2,738 patients undergoing resection for colorectal cancer liver metastases, 1168 (42%) had synchronous disease. Of these, 442 resections were simultaneous (38%) and 776 were staged (62%). The proportion of synchronous disease among patients undergoing resection increased on average 3% per year (p = 0.02). For simultaneous versus staged resection, respectively, median length of hospital stay was shorter (8 vs. 11 days, p < 0.001); rate of major liver resections was lower (17% vs. 65%, p < 0.001), major post-operative complications were similar (28% vs. 23%, p = 0.067), and 90-day post-operative mortality was higher (6% vs. 1%, p < 0.001). Chemotherapy was administered more commonly among patients undergoing staged resections (91% vs. 76%, p < 0.001). Simultaneous resection was associated with a lower median overall survival (40 months, 95%CI 35-46 vs. 78 months, 95%CI 59-86). Risk factors for lower survival included higher comorbidities, right-sided primary and simultaneous resection. Conclusion: Simultaneous resection was associated with similar post-operative complications, higher postoperative mortality and poorer long-term survival. Prospective randomized trials can inform the role of simultaneous versus staged resection for synchronous colorectal cancer liver metastases.

引用

页码：68 / 75

页数：8

共 42 条

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