학술논문
Synchronous resection of colorectal cancer primary and liver metastases: an outcomes analysis.
Document Type
Academic Journal
Author
Driedger MR; Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: mdriedge@ualberta.ca.; Yamashita TS; Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA.; Starlinger P; Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA.; Mathis KL; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.; Smoot RL; Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA.; Cleary SP; Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA.; Nagorney DM; Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA.
Source
Publisher: Elsevier Country of Publication: England NLM ID: 100900921 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1477-2574 (Electronic) Linking ISSN: 1365182X NLM ISO Abbreviation: HPB (Oxford) Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Concurrent resection of the primary cancer and synchronous colorectal cancer liver metastases (CRCLM) was evaluated for differences in outcomes following stratification of both the liver and colorectal resection.
Methods: Consecutive cases of synchronous resection of both the CRC primary and CRCLM were reviewed retrospectively at a single, high-volume institution over a 17-year period (2000-2017).
Results: 273 patients underwent simultaneous resection of CRCLM. The distribution of the primary lesion was similar between the colon (52.4%) and rectum (47.6%), while 46.9% of patients had bilobar liver disease. Major liver/major colorectal resection (n = 24) were significantly more likely to experience colorectal specific morbidity (OR 3.98, 95% CI 1.56-10.15, p = 0.004), liver specific morbidity (OR 7.4, 95% CI 2.22-24.71, p = 0.001), total morbidity (OR 2.91, 95% CI 1.18-7.18, p = 0.020) and 90-day mortality (OR 5.50, 95% CI 1.27-23.81, p = 0.023). Failure to receive adjuvant chemotherapy secondary to postoperative morbidity was associated with significantly worsened survival (HR for death 5.91, 95% CI 1.59-22.01, p = 0.008).
Conclusions: Postoperative morbidity precluding the administration of adjuvant chemotherapy is associated with an increase in mortality. Combining a major liver with major colorectal resection is associated with a significant increase in major morbidity and 90-day mortality, and should be avoided.
(Copyright © 2021 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Methods: Consecutive cases of synchronous resection of both the CRC primary and CRCLM were reviewed retrospectively at a single, high-volume institution over a 17-year period (2000-2017).
Results: 273 patients underwent simultaneous resection of CRCLM. The distribution of the primary lesion was similar between the colon (52.4%) and rectum (47.6%), while 46.9% of patients had bilobar liver disease. Major liver/major colorectal resection (n = 24) were significantly more likely to experience colorectal specific morbidity (OR 3.98, 95% CI 1.56-10.15, p = 0.004), liver specific morbidity (OR 7.4, 95% CI 2.22-24.71, p = 0.001), total morbidity (OR 2.91, 95% CI 1.18-7.18, p = 0.020) and 90-day mortality (OR 5.50, 95% CI 1.27-23.81, p = 0.023). Failure to receive adjuvant chemotherapy secondary to postoperative morbidity was associated with significantly worsened survival (HR for death 5.91, 95% CI 1.59-22.01, p = 0.008).
Conclusions: Postoperative morbidity precluding the administration of adjuvant chemotherapy is associated with an increase in mortality. Combining a major liver with major colorectal resection is associated with a significant increase in major morbidity and 90-day mortality, and should be avoided.
(Copyright © 2021 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)