Survival after repeat hepatectomy for recurrent colorectal liver metastasis: A review and meta-analysis of prognostic factors  

作　　者：Shi-Jie Wang Xiao-Ying Si Zhi-Bin Cai Yan-Ming Zhou 

机构地区：[1]Department of Hepatobiliary and Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University

出　　处：《Hepatobiliary & Pancreatic Diseases International》2019年第4期313-320,共8页国际肝胆胰疾病杂志（英文版）

基　　金：supported by a grant from Foundation of Xiamen Science and Technology Bureau(3502Z20174074)

摘　　要：Background:Frequent recurrent hepatic metastasis after hepatic metastasectomy is a major obstacle in the treatment of colorectal liver metastasis(CRLM).We performed the present systematic review to evaluate the short-and long-term outcomes after repeat hepatectomy for recurrent CRLM and determine factors associated with survival in these patients.Data sources:An electronic search of PubMed database was undertaken to identify all relevant peerreviewed papers published in English between January 20 0 0 and July 2018.Hazard ratios(HR)with 95%confidence interval(95%CI)were calculated for prognostic factors of overall survival(OS).Results:The search yielded 34 studies comprising 3039 patients,with a median overall morbidity of 23%(range 8%–71%),mortality of 0(range 0–6%),and 5-year OS of 42%(range 17%–73%).Pooled analysis showed that primary T3/T4 stage tumor(HR=1.94;95%CI:1.04–3.63),multiple tumors(HR=1.49;95%CI:1.10–2.01),largest liver lesion≥5 cm(HR=1.89;95%CI:1.11–3.23)and positive surgical margin(HR=1.80;95%CI:1.09–2.97)at initial hepatectomy,and high serum level of carcinoembryonic antigen(HR=1.87;95%CI:1.27–2.74),disease-free interval≤12 months(HR=1.34;95%CI:1.10–1.62),multiple tumors(HR=1.64;95%CI:1.32–2.02),largest liver lesion≥5 cm(HR=1.85;95%CI:1.34–2.56),positive surgical margin(HR=2.25;95%CI:1.39–3.65),presence of bilobar disease(HR=1.62;95%CI:1.19–2.20),and extrahepatic metastases(HR=1.60;95%CI:1.23–2.09)at repeat hepatectomy were significantly associated with poor OS.Background: Frequent recurrent hepatic metastasis after hepatic metastasectomy is a major obstacle in the treatment of colorectal liver metastasis(CRLM). We performed the present systematic review to evaluate the short-and long-term outcomes after repeat hepatectomy for recurrent CRLM and determine factors associated with survival in these patients. Data sources: An electronic search of Pub Med database was undertaken to identify all relevant peerreviewed papers published in English between January 2000 and July 2018. Hazard ratios(HR) with 95% confidence interval(95% CI) were calculated for prognostic factors of overall survival(OS). Results: The search yielded 34 studies comprising 3039 patients, with a median overall morbidity of 23%(range 8%–71%), mortality of 0(range 0–6%), and 5-year OS of 42%(range 17%–73%). Pooled analysis showed that primary T3/T4 stage tumor(HR = 1.94; 95% CI: 1.04–3.63), multiple tumors(HR = 1.49; 95% CI: 1.10–2.01), largest liver lesion ≥5 cm(HR = 1.89; 95% CI: 1.11–3.23) and positive surgical margin(HR = 1.80; 95% CI: 1.09–2.97) at initial hepatectomy, and high serum level of carcinoembryonic antigen(HR = 1.87; 95% CI: 1.27–2.74), disease-free interval ≤12 months(HR = 1.34; 95% CI: 1.10–1.62), multiple tumors(HR = 1.64; 95% CI: 1.32–2.02), largest liver lesion ≥5 cm(HR = 1.85; 95% CI: 1.34–2.56), positive surgical margin(HR = 2.25; 95% CI: 1.39–3.65), presence of bilobar disease(HR = 1.62; 95% CI: 1.19–2.20), and extrahepatic metastases(HR = 1.60; 95% CI: 1.23–2.09) at repeat hepatectomy were significantly associated with poor OS. Conclusions: Repeat hepatectomy is a safe and effective therapy for recurrent CRLM. Long-term outcome is predicted mainly by factors related to repeat hepatectomy.

关 键 词：COLORECTAL cancer METASTASECTOMY PROGNOSIS META-ANALYSIS 

分 类 号：R73[医药卫生—肿瘤]