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Which strategy is better for resectable synchronous liver metastasis from colorectal cancer, simultaneous surgery, or staged surgery? Multicenter retrospective analysis

Annals of Surgical Treatment and Research 2019년 97권 4호 p.184 ~ 193
 ( Kye Bong-Hyeon ) - Catholic University College of Medicine Department of Surgery

 ( Lee Suk-Hwan ) - Kyung Hee University Hospital at Gangdong Department of Surgery
 ( Jeong Woon-Kyung ) - Keimyung University Dongsan Medical Center Department of Surgery
 ( Yu Chang-Sik ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Park In-Ja ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Kim Hyeong-Rok ) - Chonnam National University Hwasun Hospital Department of Surgery
 ( Kim Jin ) - Korea University College of Medicine Korea University Anam Hospital Department of Surgery
 ( Lee In-Kyu ) - Catholic University College of Medicine Department of Surgery
 ( Park Ki-Jea ) - Dong-A University College of Medicine Department of Surgery
 ( Choi Hong-Jo ) - Dong-A University College of Medicine Department of Surgery
 ( Kim Ho-Young ) - Catholic University College of Medicine Incheon St. Mary’s Hospital Department of Surgery
 ( Baek Jeong-Heum ) - Gachon University Gil Medical Center Department of Surgery
 ( Lee Yoon-Suk ) - Catholic University College of Medicine Department of Surgery

Abstract


Purpose: The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends on various factors. The present study was intended to investigate the oncologic outcome according to the time of resection of metastatic lesions.

Methods: Data from patients who underwent treatment with curative intent for primary CRC and synchronous LM between 2004 and 2009 from 9 university hospitals in Korea were collected retrospectively. One hundred forty-three patients underwent simultaneous resection for primary CRC and synchronous LM (simultaneous surgery group), and 65 patients were treated by 2-stage operation (staged surgery group).

Results: The mean follow-up length was 41.2 ± 24.6 months. In the extent of resection for hepatic metastasis, major hepatectomy was more frequently performed in staged surgery group (33.8% vs. 8.4%, P < 0.001). The rate of severe complications of Clavien-Dindo classification grade III or more was not significantly different between the 2 groups. The 3-year overall survival (OS) rate was 85.0% in staged surgery group and 69.4% in simultaneous surgery group (P = 0.013), and the 3-year recurrence-free survival (RFS) rate was 46.4% in staged surgery group and 30.2% in simultaneous surgery group (P = 0.143). In subgroup analysis based on the location of primary CRC, the benefit of staged surgery for OS and RFS was clearly shown in rectal cancer (P = 0.021 and P = 0.015).

Conclusion: Based on our results, staged surgery with or without neoadjuvant chemotherapy should be considered for resectable synchronous LM from CRC, especially in rectal cancer, as a safe and fairly promising option.

키워드

Colorectal neoplasms; Neoplasm metastasis; Surgical oncology
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