Laparoscopic hepatectomy combined with intraoperative microwave ablation in the treatment of multiple colorectal liver metastases

doi:10.3877/cma.j.issn.1674-6899.2024.04.006

Abstract

Abstract:

Objective

To compare the postoperative complications and recurrence of multiple colorectal liver metastases (CRLM) treated by laparoscopic hepatectomy combined with microwave ablation and laparoscopic hepatectomy alone.

Methods

The clinical data of 124 patients with multiple CRLM who underwent laparoscopic hepatectomy combined with or without intraoperative microwave ablation from Dec. 2018 to Jan. 2024 were retrospectively analyzed. 42 cases (33.9%) underwent laparoscopic hepatectomy combined with microwave ablation, and 82 cases (66.1%) underwent laparoscopic hepatectomy. Univariate and multivariate Logistic regression models were used to analyze the factors associated with major postoperative complications. Kaplan-Meier survival analysis and logarithmic rank test were used to compare recurrence-free survival (RFS) in different surgical groups.

Results

The number of lesions in laparoscopic hepatectomy combined with microwave ablation group was higher (P<0.001), and the proportion of hepatic bilobar involvement was higher (P< 0.001). Complications of Clavien-Dindo grade Ⅱ and higher occurred in 20 (16.1%) patients. Multivariate analysis suggested that BMI ≥ 24.0 kg/m² (OR 5.11, 95%CI: 1.54-16.95, P=0.008)and intraoperative blood transfusion (OR 7.90, 95%CI: 1.00-62.15, P=0.050) was independent risk factors for postoperative complications. There was no significant difference in RFS between the two groups (P=0.81), and the median RFS was 8.8 and 10.2 months, respectively.

Conclusions

Laparoscopic hepatectomy combined with microwave ablation provides an opportunity for radical surgery in multiple CRLM patients with bilobar involvement. In the individual treatment of CRLM, a more aggressive radical surgical strategy can be adopted to improve the prognosis while preserving liver function.

Key words: Colorectal liver metastases, Laparoscopic hepatectomy, Microwave ablation, Postoperative complications, Recurrence-free survival

Huachuan Song, Peng Ji, Huanzhang Yao, Yongshuai Wang, Shenyu Zhang, Ruipeng Song, Jizhou Wang. Laparoscopic hepatectomy combined with intraoperative microwave ablation in the treatment of multiple colorectal liver metastases[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(04): 222-226.

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References 18

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项目	腹腔镜肝切除组(n＝82)	联合微波消融组(n＝42)	P值
男性	55 (67.07)	25 (59.52)	0.406
年龄≥60岁	32 (39.02)	18 (42.86)	0.681
BMI≥24 kg/m²	36 (43.90)	21 (50.00)	0.519
高血压	31 (37.80)	16 (38.10)	0.975
糖尿病	11 (13.41)	11 (26.19)	0.078
RAS基因突变	28 (50.91)	22 (62.86)	0.266
原发肿瘤位置，结肠	44 (53.66)	23 (56.10)	0.798
原发肿瘤淋巴结阳性	51 (69.86)	28 (75.68)	0.522
同时性肝转移	50 (60.98)	30 (73.17)	0.181
肝转移灶数目	2.00 (2.00～3.00)	3.50 (3.00～5.75)	<0.001
最大转移灶直径≥3.0 cm	29 (35.37)	12 (28.57)	0.447
肝两叶受累	30 (36.59)	29 (69.05)	<0.001
术前CEA≥10 ng/ml	33 (40.24)	14 (33.33)	0.453
术前化疗	58 (71.60)	34 (80.95)	0.258
原发灶同期手术	25 (30.49)	10 (23.81)	0.434
术中出血量(ml)	100.00 (50.00～100.00)	100.00 (50.00～100.00)	0.579
手术时间(min)	210.00 (151.25～298.25)	237.50 (180.75～317.75)	0.124
术中输血	5 (6.10)	2 (4.76)	0.760
术后住院时间(d)	7.00 (5.00～10.75)	6.50 (5.00～8.75)	0.458
术后主要并发症	15 (18.29)	5 (11.90)	0.360

项目	腹腔镜肝切除组(n＝82)	联合微波消融组(n＝42)	P值
男性	55 (67.07)	25 (59.52)	0.406
年龄≥60岁	32 (39.02)	18 (42.86)	0.681
BMI≥24 kg/m²	36 (43.90)	21 (50.00)	0.519
高血压	31 (37.80)	16 (38.10)	0.975
糖尿病	11 (13.41)	11 (26.19)	0.078
RAS基因突变	28 (50.91)	22 (62.86)	0.266
原发肿瘤位置，结肠	44 (53.66)	23 (56.10)	0.798
原发肿瘤淋巴结阳性	51 (69.86)	28 (75.68)	0.522
同时性肝转移	50 (60.98)	30 (73.17)	0.181
肝转移灶数目	2.00 (2.00～3.00)	3.50 (3.00～5.75)	<0.001
最大转移灶直径≥3.0 cm	29 (35.37)	12 (28.57)	0.447
肝两叶受累	30 (36.59)	29 (69.05)	<0.001
术前CEA≥10 ng/ml	33 (40.24)	14 (33.33)	0.453
术前化疗	58 (71.60)	34 (80.95)	0.258
原发灶同期手术	25 (30.49)	10 (23.81)	0.434
术中出血量(ml)	100.00 (50.00～100.00)	100.00 (50.00～100.00)	0.579
手术时间(min)	210.00 (151.25～298.25)	237.50 (180.75～317.75)	0.124
术中输血	5 (6.10)	2 (4.76)	0.760
术后住院时间(d)	7.00 (5.00～10.75)	6.50 (5.00～8.75)	0.458
术后主要并发症	15 (18.29)	5 (11.90)	0.360

暴露因素	例(%)	单因素分析OR(95%CI)	P值	多因素分析OR(95%CI)	P值
男性	80(64.5)	0.79(0.30, 2.12)	0.645
年龄≥60岁	50(40.3)	0.76(0.28, 2.07)	0.597
BMI≥24 kg/m²	57(46.0)	4.43(1.50, 13.11)	0.007	5.11(1.54, 16.95)	0.008
高血压	47(37.9)	1.11(0.42, 2.96)	0.833
糖尿病	22(17.7)	1.19(0.36, 4.00)	0.773
RAS基因突变	50(55.6)	0.90(0.30, 2.73)	0.850
原发肿瘤位置，结肠	67(54.5)	0.81(0.31, 2.11)	0.661
原发肿瘤淋巴结阳性	79(71.8)	1.12(0.37, 3.43)	0.842
同时性肝转移	80(65.0)	3.60(0.99, 13.07)	0.052	2.14(0.50, 9.08)	0.303
最大转移灶直径≥3.0 cm	41(33.1)	1.84(0.69, 4.88)	0.220
肝两叶受累	59(47.6)	1.12(0.43, 2.92)	0.813
术前CEA≥10 ng/ml	47(37.9)	1.11(0.42, 2.96)	0.833
原发灶同期手术	35(28.2)	4.07(1.51, 10.99)	0.006	2.55(0.81, 8.03)	0.111
腹腔镜肝切除术联合消融	42(33.9)	0.60(0.20, 1.79)	0.363
术中输血	7(5.6)	4.41(0.91, 21.48)	0.066	7.90(1.00, 62.15)	0.050

暴露因素	例(%)	单因素分析OR(95%CI)	P值	多因素分析OR(95%CI)	P值
男性	80(64.5)	0.79(0.30, 2.12)	0.645
年龄≥60岁	50(40.3)	0.76(0.28, 2.07)	0.597
BMI≥24 kg/m²	57(46.0)	4.43(1.50, 13.11)	0.007	5.11(1.54, 16.95)	0.008
高血压	47(37.9)	1.11(0.42, 2.96)	0.833
糖尿病	22(17.7)	1.19(0.36, 4.00)	0.773
RAS基因突变	50(55.6)	0.90(0.30, 2.73)	0.850
原发肿瘤位置，结肠	67(54.5)	0.81(0.31, 2.11)	0.661
原发肿瘤淋巴结阳性	79(71.8)	1.12(0.37, 3.43)	0.842
同时性肝转移	80(65.0)	3.60(0.99, 13.07)	0.052	2.14(0.50, 9.08)	0.303
最大转移灶直径≥3.0 cm	41(33.1)	1.84(0.69, 4.88)	0.220
肝两叶受累	59(47.6)	1.12(0.43, 2.92)	0.813
术前CEA≥10 ng/ml	47(37.9)	1.11(0.42, 2.96)	0.833
原发灶同期手术	35(28.2)	4.07(1.51, 10.99)	0.006	2.55(0.81, 8.03)	0.111
腹腔镜肝切除术联合消融	42(33.9)	0.60(0.20, 1.79)	0.363
术中输血	7(5.6)	4.41(0.91, 21.48)	0.066	7.90(1.00, 62.15)	0.050

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