Debulking hepatectomy for colorectal liver metastasis: Analysis of risk factors for progression free survival.

Autor: Mazzotta AD; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, Boulevard Jourdan, 75014, Paris, France. Electronic address: alex.mazzotta@gmail.com., Usdin N; Département d'oncologie Médicale, Institut Mutualiste Montsouris, 42, Boulevard Jourdan, 75014, Paris, France., Samer D; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, Boulevard Jourdan, 75014, Paris, France., Tribillon E; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, Boulevard Jourdan, 75014, Paris, France., Gayet B; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, Boulevard Jourdan, 75014, Paris, France., Fuks D; Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France; Université de Paris, Faculté de Médecine, 75006, Paris, France., Louvet C; Département d'oncologie Médicale, Institut Mutualiste Montsouris, 42, Boulevard Jourdan, 75014, Paris, France., Soubrane O; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, Boulevard Jourdan, 75014, Paris, France.
Jazyk: angličtina
Zdroj: Surgical oncology [Surg Oncol] 2024 Aug; Vol. 55, pp. 102056. Date of Electronic Publication: 2024 Mar 12.
DOI: 10.1016/j.suronc.2024.102056
Abstrakt: Background: The study explores the role of liver debulking surgery in cases of unresectable colorectal liver metastases (CRLM), challenging the traditional notion that surgery is not a valid option in such scenarios.
Materials and Methods: Patients with advanced but resectable disease who underwent surgery with a curative intent (Group I) and those with advanced incompletely resectable disease who underwent a "debulking" hepatectomy (Group II) were compared.
Results: There was no difference in the intra-operative and post-operative results between the two groups. The 3-year and 5-year OS rates were 69% and 47% for group 1 vs 64% and 35% for group 2 respectively (p = 0.14). The 3-year and 5-year PFS rates were 32% and 21% for group 1 vs 12% and 8% for group 2 respectively (p = 0.009). Independent predictors of PFS in the debulking group were bilobar metastases (HR = 2.70; p = 0.02); the presence of extrahepatic metastasis (HR = 2.65, p = 0.03) and the presence of more than 9 metastases (HR = 2.37; p = 0.04). Iterative liver surgery for CRLM was a significant protective factor (HR = 0.34, p = 0.04).
Conclusion: An aggressive palliative surgical approach may offer a survival benefit for selected patients with unresectable CRLM, without increasing the morbidity. The decision for surgery should be made on a case-by-case basis.
Competing Interests: Conflict of interest/disclosure The authors have no conflicts of interests or disclosures to report.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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