Chirurgia del Fegato a Firenze!

Dal 1° Marzo 2023, Chirurgia del Fegato sarà all'Università di Firenze
AOUC Azienda Ospedaliero-Universitaria Careggi - Largo Brambilla, 3 - 50134 Firenze

Il primo sistema di prognosi per i pazienti resecati per metastasi epatiche da tumori del colon retto

Il chirurgo statunitense Yuman Fong, dal Memorial Sloan-Kettering Cancer Center di New York City, pubblica uno score clinico per predire la recidiva delle metastasi epatiche da tumore del colon-retto dopo la resezione epatica.

Questo lavoro sarà il n. 1 dei 100 lavori più citati fra quelli presentati nel meeting dell’American Surgical Association e pubblicati dal 1955 al 2010 sulla rivista Annals of Surgery.

Fonte: Landreneau JP,  The 100 Most Cited Papers in the History of the American Surgical Association. Ann Surg. 2020;271:663-670. doi: 10.1097/SLA.0000000000003633. 

La referenza bibliografica per questo evento è:

Yuman Fong, Joseph Fortner, Ruth L. Sun, Murray F. Brennan, Leslie H. Blumgart: Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: Analysis of 1001 consecutive cases. In: Annals of Surgery, vol. 230, no. 3, pp. 309 – 321, 1999, ISSN: 00034932, (Cited by: 3043; All Open Access, Green Open Access).

Abstract

Objective: There is a need for clearly defined and widely applicable clinical criteria for the selection of patients who may benefit from hepatic resection for metastatic colorectal cancer. Such criteria would also be useful for stratification of patients in clinical trials for this disease. Methods: Clinical, pathologic, and outcome data for 1001 consecutive patients undergoing liver resection for metastatic colorectal cancer between July 1985 and October 1998 were examined. These resections included 237 trisegmentectomies, 394 lobectomies, and 370 resections encompassing less than a lobe. The surgical mortality rate was 2.8%. Results: The 5-year survival rate was 37%, and the 10-year survival rate was 22%. Seven factors were found to be significant and independent predictors of poor long-term outcome by multivariate analysis: positive margin (p = 0.004), extrahepatic disease (p = 0.003), node-positive primary (p = 0.02), disease-free interval from primary to metastases <12 months (p = 0.03), number of hepatic tumors >1 (p = 0.0004), largest hepatic tumor >5 cm (p = 0.01), and carcinoembryonic antigen level >200 ng/ml (p = 0.01). When the last five of these criteria were used in a preoperative scoring system, assigning one point for each criterion, the total score was highly predictive of outcome (p < 0.0001). No patient with a score of 5 was a long-term survivor. Conclusion: Resection of hepatic colorectal metastases may produce long-term survival and cure. Long- term outcome can be predicted from five criteria that are readily available for all patients considered for resection. Patients with up to two criteria can have a favorable outcome. Patients with three, four, or five criteria should be considered for experimental adjuvant trials. Studies of preoperative staging techniques or of adjuvant therapies should consider using such a score for stratification of patients.

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Chirurgia del Fegato all'Università di Firenze!

Chirurgia Epato-Bilio-Pancreatica

AOUC Azienda Ospedaliero-Universitaria Careggi
Largo Brambilla, 3 – 50134 Firenze

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