摘要
目的探讨初始可切除同时性直肠癌肝转移一期同步切除的安全性和有效性。方法回顾性选择2016年1月至2020年6月于复旦大学附属中山医院确诊为初始可切除直肠癌肝转移的患者305例,其中肠肝同步切除患者191例,分期切除患者114例。采用倾向性评分匹配对两组患者按照1∶1进行匹配,比较患者临床资料,并绘制KaplanMeier生存曲线。结果倾向性评分匹配后,同步切除组和分期切除组各纳入85例患者,两组患者一般资料差异无统计学意义。除肝转移灶手术方式外,两组患者的原发灶手术方式、术中失血量、术中并发症、术后首次排气和排便时间、术后30 d内死亡率以及术后住院天数差异均无统计学意义。同步切除组总体并发症发生率高于分期切除组(48.2%vs29.4%,P=0.04),其中,同步切除组的Ⅱ级并发症发生率显著高于分期切除组(29.4%vs 14.1%,P=0.016),而两组患者Ⅲ~Ⅴ级严重并发症发生率差异无统计学意义(18.8%vs 15.3%)。同步切除组和分期切除组的中位无疾病进展期(HR=0.70,95%CI 0.50~0.97,P=0.103)和5年总生存率(HR=0.95,95%CI 0.63~1.44,P=0.259)差异无统计学意义。结论初始可切除直肠癌肝转移一期同步切除具有与分期切除相当的安全性和有效性。
Objective To evaluate the safety and efficacy of simultaneous resection for initially resectable rectal cancer with synchronous liver metastases.Methods A retrospective analysis was conducted on 305 patients with initially resectable rectal cancer with synchronous liver metastases.These patients were diagnosed at Zhongshan Hospital,Fudan University from January 2016 to June 2020.Among them,191 underwent simultaneous rectum and liver resection and 114 underwent staged resection.Propensity score matching(PSM)was performed at a 1∶1 ratio.Clinical data were compared and Kaplan-Meier survival curves were plotted.Results After PSM,85 patients were included in each group.General data showed no significant differences.Except for liver metastasis resection method,no statistical differences were found in primary tumor surgery approach,intraoperative blood loss,intraoperative complications,time to first flatus and defecation,30-day mortality,and postoperative hospital stay between the simultaneous resection group and the staged resection group.The overall complication rate was higher in the simultaneous resection group(48.2%vs 29.4%,P=0.04).Specifically,the gradeⅡcomplications were significantly higher(29.4%vs 14.1%,P=0.016),but there’s no differences in severe complications(gradeⅢ-Ⅴ).No statistically differences were observed in median progression-free survival(HR=0.70,95%CI 0.50-0.97,P=0.103)and 5-year overall survival(HR=0.95,95%CI 0.63-1.44,P=0.259).Conclusions Simultaneous resection demonstrates comparable safety and efficacy to staged resection for initially resectable rectal cancer with synchronous liver metastases.
作者
黄哲昆
吕洋
林松斌
许剑民
汤文涛
HUANG Zhekun;LU Yang;LIN Songbin;XU Jianmin;TANG Wentao(Department of General Surgery,Zhongshan Hospital(Xiamen Branch),Fudan University,Xiamen 361015,Fujian,China;Department of Colorectal Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中国临床医学》
2025年第3期355-361,共7页
Chinese Journal of Clinical Medicine
基金
上海市自然科学基金(23ZR1410600)。
关键词
初始可切除直肠癌肝转移
同步切除
分期切除
initially resectable rectal cancer with liver metastases
simultaneous resection
staged resection
