Proposal of "borderline resectable" colorectal liver metastases based on analysis of risk factors for early surgical failure.

IF 1.7 4区医学 Q2 SURGERY

Surgery Today Pub Date : 2025-03-01 Epub Date: 2024-08-19 DOI:10.1007/s00595-024-02920-z

Mizuki Ninomiya, Shinji Itoh, Kazuki Takeishi, Takeo Toshima, Shohei Yoshiya, Kazutoyo Morita, Ryosuke Minagawa, Tomohiro Iguchi, Eiji Oki, Tomoharu Yoshizumi

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引用次数: 0

Abstract

Purpose: We aimed to define borderline resectable colorectal liver metastases (CRLM) based on the analysis of risk factors for early surgical failure and investigate the efficacy of neoadjuvant chemotherapy in these patients.

Methods: This was a retrospective analysis of a multi-institutional cohort of patients diagnosed with technically resectable CRLM. Early surgical failure within 6 months of liver surgery was defined as ESF6. We classified CRLM into three grades (A, B, and C) according to the definition of the Japanese Society for Cancer of the Colon and Rectum.

Results: Among the 249 patients with technically resectable CRLM, 46 (18.5%) developed ESF6. The survival rate of these patients was significantly lower than that of the patients without ESF6. In the multivariate analysis of synchronous CRLM patients, no neoadjuvant chemotherapy, Grade B/C, and Charlson comorbidity index ≥ 3 were independent predictors of ESF6. Among patients with synchronous and Grade B/C CRLM, ESF6 rates, surgical failure-free survival, and overall survival in the neoadjuvant chemotherapy group were significantly better relative to the upfront surgery group.

Conclusions: Patients with synchronous and Grade B/C CRLM are at a high risk of early surgical failure, have a poor long-term prognosis, and can be defined as borderline resectable and good candidates for neoadjuvant chemotherapy.

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根据早期手术失败风险因素分析，提出 "边缘可切除 "结直肠肝转移瘤的建议。

目的：我们旨在根据对早期手术失败风险因素的分析界定可切除边界结直肠肝转移瘤（CRLM），并研究新辅助化疗对这些患者的疗效：这是对多所医院诊断为技术上可切除的 CRLM 患者队列的回顾性分析。肝脏手术后6个月内的早期手术失败被定义为ESF6。根据日本结肠直肠癌协会的定义，我们将 CRLM 分为三个等级（A、B 和 C）：在 249 例技术上可切除的 CRLM 患者中，有 46 例（18.5%）发展为 ESF6。这些患者的生存率明显低于无 ESF6 的患者。在同步CRLM患者的多变量分析中，未接受新辅助化疗、B/C级和Charlson合并症指数≥3是预测ESF6的独立因素。在同步和B/C级CRLM患者中，新辅助化疗组的ESF6率、无手术失败生存率和总生存率明显优于前期手术组：结论：同步和B/C级CRLM患者早期手术失败风险高，长期预后差，可定义为边缘可切除，是新辅助化疗的良好候选者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery Today 医学-外科

CiteScore

4.90

自引率

4.00%

发文量

208

审稿时长

1 months

期刊介绍： Surgery Today is the official journal of the Japan Surgical Society. The main purpose of the journal is to provide a place for the publication of high-quality papers documenting recent advances and new developments in all fields of surgery, both clinical and experimental. The journal welcomes original papers, review articles, and short communications, as well as short technical reports("How to do it"). The "How to do it" section will includes short articles on methods or techniques recommended for practical surgery. Papers submitted to the journal are reviewed by an international editorial board. Field of interest: All fields of surgery.