RE-HEPATECTOMY MEANS MORE MORBIDITY? A MULTICENTRIC ANALYSIS

ABSTRACT - BACKGROUND: Colorectal cancer generally metastasizes to the liver. Surgical resection of liver metastasis, which is associated with systemic chemotherapy, is potentially curative, but many patients will present recurrence. In selected patients, repeated hepatectomy is feasible and improves overall survival. AIM: This study aimed to analyze patients with colorectal liver metastasis (CRLM) submitted to hepatectomy in three centers from Rio de Janeiro, over the past 10 years, by comparing the morbidity of first hepatectomy and re-hepatectomy. METHODS: From June 2009 to July 2020, 192 patients with CRLM underwent liver resection with curative intent in three hospitals from Rio de Janeiro Federal Health System. The data from patients, surgeries, and outcomes were collected from a prospectively maintained database. Patients submitted to first and re-hepatectomies were classified as Group 1 and Group 2, respectively. Data from groups were compared and value of p<0.05 was considered significant. RESULTS: Among 192 patients, 16 were excluded. Of the remaining 176 patients, 148 were included in Group 1 and 28 were included in Group 2. Fifty-five (37.2%) patients in Group 1 and 13 (46.5%) in Group 2 presented postoperative complications. Comparing Groups 1 and 2, we found no statistical difference between the cases of postoperative complications (p=0.834), number of minor (p=0.266) or major (p=0.695) complications, and deaths (p=0.407). CONCLUSIONS: No differences were recorded in morbidity or mortality between patients submitted to first and re-hepatectomies for CRLM, which reinforces that re-hepatectomy can be performed with outcomes comparable to first hepatectomy.

摘要
背景：结直肠癌通常发生肝转移。联合全身化疗的肝转移灶手术切除具备潜在治愈价值，但多数患者仍会出现复发。经筛选的患者可接受再次肝切除术，且该术式可改善患者总生存期。
目的：本研究旨在分析过去10年间，里约热内卢三家医疗中心收治的结直肠癌肝转移（colorectal liver metastasis, CRLM）患者的临床数据，对比首次肝切除术与再次肝切除术的术后并发症发生情况。
方法：2009年6月至2020年7月，里约热内卢联邦医疗体系下属三家医院共纳入192例拟行根治性肝切除术的结直肠癌肝转移患者。研究数据来自前瞻性维护的数据库，涵盖患者基线特征、手术相关信息及预后结局。将接受首次肝切除术的患者设为第1组，接受再次肝切除术的患者设为第2组。对两组数据进行比较分析，以p<0.05为差异具有统计学意义。
结果：本研究初始纳入192例患者，其中16例被排除。剩余176例患者中，148例归入第1组，28例归入第2组。第1组有55例（37.2%）患者出现术后并发症，第2组有13例（46.5%）出现术后并发症。对比两组数据可见，术后并发症发生率（p=0.834）、轻度并发症例数（p=0.266）、重度并发症例数（p=0.695）及术后死亡率（p=0.407）均无统计学差异。
结论：结直肠癌肝转移患者接受首次或再次肝切除术的术后并发症发生率及死亡率无显著差异，这一结果证实再次肝切除术的预后效果可与首次肝切除术相媲美。