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在接受结直肠肝转移的第二次和第三次切除的患者中,复发的风险不会降低

Yuhi Yoshizaki¹, Yoshikuni Kawaguchi², Yusuke Seki²

¹Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.

HPB : the official journal of the International Hepato Pancreato Biliary Association

|April 9, 2025

概括

对结直肠肝转移 (CLM) 进行重复肝切除,与第一次相比,第二次和第三次手术的复发风险类似. 监测策略应在重复的CLM切除中保持一致.

科学领域:

在瘤学瘤学.
手术瘤学手术瘤学
肝胆道手术肝胆道手术

背景情况:

重复切除肝脏是复发性结直肠肝转移 (CLM) 的标准治疗方法.
在第二次和第三次CLM切除后复发的风险尚未先前评估.
了解重复切除后的复发模式对于优化患者管理至关重要.

研究的目的:

评估和比较第一次,第二次和第三次肝脏切除后复发的风险.
为了确定第二次CLM切除后复发的风险因素.
为CLM重复切除肝脏后的监测策略提供信息.

主要方法:

对前性维护的数据库进行回顾性分析.
包括在2005年至2018年期间接受第一次,第二次或第三次CLM切除的患者.
统计分析以比较复发风险并确定风险因素.

主要成果:

来自695名患者的数据:486人 (第一次),159人 (第二次) 和50人 (第三次切除).
复发风险和累积复发曲线在第一个,第二个和第三个CLM切除中是相似的.
第二次切除后复发的显著风险因素包括第一次切除后 ≤12个月的复发时间 (HR 2.09) 和CLM的数量 (HR 1.07).

结论:

接受第二次和第三次CLM切除的患者面临的复发风险与第一次切除的患者相似.
目前在第一次CLM切除后采用的监测策略适用于接受后续切除的患者.
在CLM患者的所有重复肝切除术中,建议采用一致的监测方案.

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