Background

Surgical resection for patients with hepatic and extrahepatic colorectal metastases remains controversial. This study aimed to determine the efficacy of curative resection of distant extrahepatic metastatic lesions in patients with colorectal liver metastases (CRLM).

Methods

From 2007 to 2019, 377 patients with CRLM were treated; of these, 323 patients underwent hepatectomy, and 54 patients with extrahepatic metastases (EHM) had received only chemotherapy. Survival and recurrence were compared between patients with and without EHM. Variables potentially associated with survival were analyzed in univariate and multivariate analyses.

Results

Among patients who underwent hepatectomy, the median, 3-, and 5-year overall survival rates for patients with EHM (n = 60) were 32 months, 47%, and 28%, respectively, while those for patients without EHM (n = 263) were 115 months, 79%, and 66%, respectively (p < 0.001). Furthermore, outcomes were similar in R2 patients with EHM and those with unresectable tumors. However, outcomes were significantly better in the R0/1 group than in the R2 and unresectable groups (p < 0.001). Among patients with EHM, multivariate analysis revealed that higher clinical risk score, incomplete resection of all EHM, extrahepatic disease detected intraoperatively, and previous treatment with neoadjuvant chemotherapy were independently associated with worse survival.

Conclusions

In patients with CRLM with EHM (liver + one organ), gross curative resection is necessary when surgical treatment is contemplated, and resection of liver metastases should be performed in patients with CRLM with smaller and fewer tumors (e.g., H1).

中文翻译：

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肝外转移的结直肠癌肝转移患者手术治疗有效还是禁忌？

背景

肝和肝外结直肠转移患者的手术切除仍存在争议。本研究旨在确定对结直肠肝转移 (CRLM) 患者进行远距离肝外转移病灶根治性切除的疗效。

方法

2007-2019年共收治CRLM患者377例；其中，323 名患者接受了肝切除术，54 名肝外转移 (EHM) 患者仅接受了化疗。比较有和无 EHM 患者的存活率和复发率。在单变量和多变量分析中分析了可能与生存相关的变量。

结果

在接受肝切除术的患者中，EHM 患者（n  = 60）的中位、3 年和 5 年总生存率分别为 32 个月、47% 和 28%，而没有 EHM 的患者（n  = 263) 分别为 115 个月、79% 和 66% ( p  < 0.001)。此外，在患有 EHM 的 R2 患者和患有不可切除肿瘤的患者中，结果相似。然而，R0/1 组的结果明显好于 R2 和不可切除组（p < 0.001)。在 EHM 患者中，多变量分析显示，较高的临床风险评分、所有 EHM 切除不完全、术中检测到肝外疾病以及既往接受新辅助化疗与较差的生存率独立相关。

结论

对于伴有 EHM（肝脏 + 一个器官）的 CRLM 患者，考虑手术治疗时需要大体根治性切除，对于肿瘤较小且较少（例如 H1）的 CRLM 患者，应进行肝转移切除术。