Сравнение паренхимосберегающих и анатомических резекций при метастазах колоректального рака в печени: метаанализ

Цель. Метаанализ публикаций, посвященных сравнению паренхимосберегающих и анатомических резекций печени.

Материал и методы. В базах данных PubMed, Web of Science, Scopus, Embase и Cochrane Library до 31.12.2024 провели поиск исследований, посвященных сравнению паренхимосберегающих и анатомических резекций при метастазах колоректального рака в печени.

Результаты. Проводили сравнение результатов ретроспективных исследований (21 работа). По результатам анализа установили, что паренхимосберегающие резекции отличались меньшей длительностью (ВРС −39,11; 95% ДИ [−64,73, −13,49]; р = 0,003), кровопотерей (ВРС −278,86; 95% ДИ [−465,88, −91,83]; р = 0,003), продол- жительностью госпитализации (ВРС −1,81; 95% ДИ [−2,96, −0,67]; р = 0,002). Частота послеоперационных осложнений статистически не отличалась. Послеоперационная летальность (ОШ 0,29; 95% ДИ [0,18, 0,46]; р < 0,00001), частота послеоперационной печеночной недостаточности (ОШ 0,17; 95% ДИ [0,07, 0,38]; р = 0,00001) и частота послеоперационных гемотрансфузий (ОШ 0,40; 95% ДИ [0,22, 0,75]; р = 0,004) были больше при анатомических резекциях. Общая (ОР 1,07; 95% ДИ [0,97, 1,17]; р = 0,2) и безрецидивная (ОР 1,09; 95% ДИ [0,98, 1,21]; р = 0,11) выживаемость статистически не отличались. Частота рецидива (ОШ 1,41; 95% ДИ [0,94, 2,10]; р = 0,10) и положительный край резекции (ОШ 1,39; 95% ДИ [0,97, 1,99]; р = 0,07) достоверно не отличались.

Заключение. Проведенный анализ демонстрирует преимущества в непосредственных результатах паренхимо-сберегающих резекций по сравнению с анатомическими при сопоставимых отдаленных результатах.

1. Benson A.B., Venook A.P., Al-Hawary M.M., Arain M.A., Chen Y.J., Ciombor K.K., Cohen S., Cooper H.S., Deming D., Farkas L., Garrido-Laguna I., Grem J.L., Gunn A., Hecht J.R., Hoffe S., Hubbard J., Hunt S., Johung K.L., Kirilcuk N., Krishnamurthi S., Gurski L.A. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Canc. Netw. 2021; 19 (3): 329–359. https://doi.org/10.6004/jnccn.2021.0012

2. Chan K.M., Wu T.H., Cheng C.H., Lee W.C., Chiang J.M., Chen J.S., Wang J.Y. Prognostic significance of the number of tumors and aggressive surgical approach in colorectal cancer hepatic metastasis. World J. Surg. Oncol. 2014; 12: 155. https://doi.org/10.1186/1477-7819-12-155

3. Lintoiu-Ursut B., Tulin A., Constantinoiu S. Recurrence after hepatic resection in colorectal cancer liver metastasis. J. Med. Life. 2015; 8 Spec Issue (Spec Issue): 12–14.

4. Nanji S., Tsang M.E., Wei X., Booth C.M. Outcomes after repeat hepatic resection for recurrent metastatic colorectal cancer: a population-based study. Am. J. Surg. 2017; 213 (6): 1053–1059. https://doi.org/10.1016/j.amjsurg.2016.08.014

5. Haddaway N.R., Page M.J., Pritchard C.C., McGuinness L.A. PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell. Syst. Rev. 2022; 18 (2): e1230. https://doi.org/10.1002/cl2.1230

6. Luo D., Wan X., Liu J., Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or midquartile range. Stat. Methods Med. Res. 2018; 27 (6): 1785–1805. https://doi.org/10.1177/0962280216669183

7. Wan X., Wang W., Liu J., Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/ or interquartile range. BMC Med. Res. Methodol. 2014; 14: 135. https://doi.org/10.1186/1471-2288-14-135

8. Tierney J.F., Stewart L.A., Ghersi D., Burdett S., Sydes M.R. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007; 8 (1): 16. https://doi.org/10.1186/1745-6215-8-16

9. Shi L., Lin L. The trim-and-fill method for publication bias: practical guidelines and recommendations based on a large database of meta-analyses. Medicine. 2019; 98 (23): e15987. https://doi.org/10.1097/MD.0000000000015987

10. DeMatteo R.P., Palese C., Jarnagin W.R., Sun R.L., Blumgart L.H., Fong Y. Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J. Gastrointest. Surg. 2000; 4 (2): 178–184. https://doi.org/10.1016/s1091-255x(00)80054-2

11. Kokudo N., Tada K., Seki M., Ohta H., Azekura K., Ueno M., Matsubara T., Takahashi T., Nakajima T., Muto T. Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma. Am. J. Surg. 2001; 181 (2): 153–159. https://doi.org/10.1016/s0002-9610(00)00560-2

12. Zorzi D., Mullen J.T., Abdalla E.K., Pawlik T.M., Andres A., Muratore A., Curley S.A., Mentha G., Capussotti L., Vauthey J.N. Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J. Gastrointest. Surg. 2006; 10 (1): 86–94. https://doi.org/10.1016/j.gassur.2005.07.022

13. Finch R.J.B., Malik H.Z., Hamady Z.Z.R., Al-Mukhtar A., Adair R., Prasad K.R., Lodge J.P.A., Toogood G.J. Effect of type of resection on outcome of hepatic resection for colorectal metastases. Br. J. Surg. 2007; 94 (10): 1242–1248. https://doi.org/10.1002/bjs.5640

14. Guzzetti E., Pulitanò C., Catena M., Arru M., Ratti F., Finazzi R., Aldrighetti L., Ferla G. Impact of type of liver resection on the outcome of colorectal liver metastases: a casematched analysis. J. Surg. Oncol. 2008; 97 (6): 503–507. https://doi.org/10.1002/jso.20979

15. Sarpel U., Bonavia A.S., Grucela A., Roayaie S., Schwartz M.E., Labow D.M. Does anatomic versus nonanatomic resection affect recurrence and survival in patients undergoing surgery for colorectal liver metastasis? Ann. Surg. Oncol. 2009; 16 (2): 379–384. https://doi.org/10.1245/s10434-008-0218-2

16. Lalmahomed Z., Ayez N., Pool A., Verheij J., IJzermans J.N.M., Verhoef K. Anatomical versus nonanatomical resection of colorectal liver metastases: is there a difference in surgical and oncological outcome? World J. Surg. 2011; 35 (3): 656–661. https://doi.org/10.1007/s00268-010-0890-9

17. Van Dam R.M., Lodewick T.M., Van Den Broek M.A.J., De Jong M.C., Greve J.W., Jansen R.L.H., Bemelmans M.H.A., Neumann U.P., Olde Damink S.W.M., Dejong C.H.C. Outcomes of extended versus limited indications for patients undergoing a liver resection for colorectal cancer liver metastases. HPB. 2014; 16 (6): 550–559. https://doi.org/10.1111/hpb.12181

18. Mise Y., Aloia T.A., Brudvik K.W., Schwarz L., Vauthey J., Conrad C. Parenchymal-sparing hepatectomy in colorectal liver metastasis improves salvageability and survival. Ann. Surg. 2016; 263 (1): 146–152. https://doi.org/10.1097/SLA.0000000000001194

19. Pandanaboyana S., Bell R., White A., Pathak S., Hidalgo E., Lodge P., Prasad R., Toogood G. Impact of parenchymal preserving surgery on survival and recurrence after liver resection for colorectal liver metastasis. ANZ J. Surg. 2018; 88 (1–2): 66–70. https://doi.org/10.1111/ans.13588

20. Matsuki R., Mise Y., Saiura A., Inoue Y., Ishizawa T., Takahashi Y. Parenchymal-sparing hepatectomy for deep-placed colorectal liver metastases. Surgery. 2016; 160 (5): 1256–1263. https://doi.org/10.1016/j.surg.2016.06.041

21. Memeo R., de Blasi V., Adam R., Goéré D., Azoulay D., Ayav A., Gregoire E., Kianmanesh R., Navarro F., Sa Cunha A., Pessaux P., Cosse C., Lignier D., Regimbeau J.M., Barbieux J., Lermite E., Hamy A., Mauvais F., Laurent C., Naasan I Al, Laurent A., Compagnon P., Sbai Idrissi M., Martin F., Atger J., Baulieux J., Darnis B., Mabrut J.Y., Kepenekian V., Perinel J., Adham M., Glehen O., Rivoire M., Hardwigsen J., Palen A., Le Treut Y.P., Delpero J.R., Turrini O., Herrero A., Panaro F., Bresler L., Rauch P., Guillemin F., Marchal F., Gugenheim J., Iannelli A., Benoist S., Brouquet A., Pocard M., Dico R.L., Fuks D., Scatton O., Soubrane O., Vaillant J.C., Piardi T., Sommacale D., Kianmanesh R., Comy M., Bachellier P., Oussoultzoglou E., Addeo P., Ntourakis D., Mutter D., Marescaux J., Raoux L., Suc B., Muscari F., Elhomsy G., Gelli M., Castaing D., Cherqui D., PIttau G., Ciacio O., Vibert E., Elias D., Vittadello F. Parenchymal-sparing hepatectomies (PSH) for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results: a propensity score matching analysis. HPB. 2016; 18 (9): 781–790. https://doi.org/10.1016/j.hpb.2016.06.004

22. Lordan J.T., Roberts J.K., Hodson J., Isaac J., Muiesan P., Mirza D.F., Marudanayagam R., Sutcliffe R.P. Case-controlled study comparing peri-operative and cancer-related outcomes after major hepatectomy and parenchymal sparing hepatectomy for metastatic colorectal cancer. HPB. 2017; 19 (8): 688–694. https://doi.org/10.1016/j.hpb.2017.04.007

23. Matsumura M., Mise Y., Saiura A., Inoue Y., Ishizawa T., Ichida H., Matsuki R., Tanaka M., Takeda Y., Takahashi Y. Parenchymal-sparing hepatectomy does not increase intrahepatic recurrence in patients with advanced colorectal liver metastases. Ann. Surg. Oncol. 2016; 23 (11): 3718–3726. https://doi.org/10.1245/s10434-016-5278-0

24. Hosokawa I., Allard M.A., Mirza D.F., Kaiser G., Barroso E., Lapointe R., Laurent C., Ferrero A., Miyazaki M., Adam R. Outcomes of parenchyma-preserving hepatectomy and right hepatectomy for solitary small colorectal liver metastasis: a LiverMetSurvey study. Surgery. 2017; 162 (2): 223–232. https://doi.org/10.1016/j.surg.2017.02.012

25. Donadon M., Cescon M., Cucchetti A., Cimino M., Costa G., Pesi B., Ercolani G., Pinna A.D., Torzilli G. Parenchymalsparing surgery for the surgical treatment of multiple colorectal liver metastases is a safer approach than major hepatectomy not impairing patients’ prognosis: a bi-institutional propensity score-matched analysis. Dig. Surg. 2018; 35 (4): 342–349. https://doi.org/10.1159/000479336

26. Spelt L., Ansari D., Swanling M., Holka P., Andersson R. Parenchyma-sparing hepatectomy (PSH) versus non-PSH for bilobar liver metastases of colorectal cancer. Ann. Gastroenterol. 2018; 31 (1): 115–120. https://doi.org/10.20524/aog.2017.0205

27. Brown K.M., Albania M.F., Samra J.S., Kelly P.J., Hugh T.J. Propensity score analysis of non-anatomical versus anatomical resection of colorectal liver metastases. BJS Open. 2019; 3 (4): 521–531. https://doi.org/10.1002/bjs5.50154

28. Okumura S., Tabchouri N., Leung U., Tinguely P., Louvet C., Beaussier M., Gayet B., Fuks D. Laparoscopic parenchymalsparing hepatectomy for multiple colorectal liver metastases improves outcomes and salvageability: a propensity scorematched analysis. Ann. Surg. Oncol. 2019; 26 (13): 4576–4586. https://doi.org/10.1245/s10434-019-07902-x

29. Hoi W., Tan S., Cheung T., Wing K., Simon M., Wing H.Y.T., Dai C. Anatomical versus nonanatomical resection for colorectal liver metastasis. World J. Surg. 2020; 44 (8): 2743–2751. https://doi.org/10.1007/s00268-020-05506-1

30. Ахаладзе Г.Г., Гончаров С.В., Рагимов В.А., Балиев З.Э. Сравнительный анализ методов паренхимасберегающей и анатомической резекции при метастазах колоректального рака в печени с использованием метода псевдорандомизации. Анналы хирургической гепатологии. 2024; 29 (4): 90–97. https://doi.org/10.16931/1995-5464.2024-4-90-97

31. Muratore A., Ribero D., Zimmitti G., Mellano A., Langella S., Capussotti L. Resection margin and recurrence-free survival after liver resection of colorectal metastases. Ann. Surg. Oncol. 2010; 17 (5): 1324–1329. https://doi.org/10.1245/s10434-009-0770-4

32. Figueras J., Burdio F., Ramos E., Torras J., Llado L., Lopez- Ben S., Codina-Barreras A., Mojal S. Effect of subcentimeter nonpositive resection margin on hepatic recurrence in patients undergoing hepatectomy for colorectal liver metastases. Evidences from 663 liver resections. Ann. Oncol. 2007; 18 (7): 1190–1195. https://doi.org/10.1093/annonc/mdm106

33. Pawlik T.M., Scoggins C.R., Zorzi D., Abdalla E.K., Andres A., Eng C., Curley S.A., Loyer E.M., Muratore A., Mentha G., Capussotti L., Vauthey J.N. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann. Surg. 2005; 241 (5): 715–722, discussion 722–724. https://doi.org/10.1097/01.sla.0000160703.75808.7d

34. Andreou A., Gloor S., Inglin J., Di Pietro Martinelli C., Banz V., Lachenmayer A., Kim-Fuchs C., Candinas D., Beldi G. Parenchymal-sparing hepatectomy for colorectal liver metastases reduces postoperative morbidity while maintaining equivalent oncologic outcomes compared to non-parenchymalsparing resection. Surg. Oncol. 2021; 38: 101631. https://doi.org/10.1016/j.suronc.2021.101631

35. Sakamoto K., Beppu T., Ogawa K., Tamura K., Honjo M., Funamizu N., Takada Y. Prognostic impact of surgical margin width in hepatectomy for colorectal liver metastasis. J. Clin. Transl. Hepatol. 2023; 11 (3): 705–717. https://doi.org/10.14218/JCTH.2022.00383

36. Патютко Ю.И., Иванов А.А., Подлужный Д.В., Котель- ников А.Г., Поляков А.Н., Магомедов М.М. Повторные резекции печени у больных колоректальным раком с мета- стазами. Анналы хирургической гепатологии. 2019; 24 (4): 56–64. https://doi.org/10.16931/1995-5464.2019456-64 https://doi.org/10.16931/1995-5464.2019456-64 (In Russian)

37. Wurster E.F., Tenckhoff S., Probst P., Jensen K., Dölger E., Knebel P., Diener M.K., Büchler M.W., Ulrich A. A systematic review and meta-analysis of the utility of repeated versus single hepatic resection for colorectal cancer liver metastases. HPB. 2017; 19 (6): 491–497. https://doi.org/10.1016/j.hpb.2017.02.440

38. Hellingman T., de Swart M.E., Heymans M.W., Jansma E.P., van der Vliet H.J., Kazemier G. Repeat hepatectomy justified in patients with early recurrence of colorectal cancer liver metastases: a systematic review and meta-analysis. Cancer Epidemiol. 2021; 74: 101977. https://doi.org/10.1016/j.canep.2021.101977

39. Takamoto T., Hashimoto T., Miyata A., Shimada K., Maruyama Y., Makuuchi M. Repeat hepatectomy after major hepat ectomy for colorectal liver metastases. J. Gastrointest. Surg. 2020; 24 (2): 380–387. https://doi.org/10.1007/s11605- 019-04154-8