Эволюция изменения подходов в хирургии злокачественных новообразований печени

Ахаладзе Г.Г.; Гончаров С.В.; Рагимов В.А.; Балиев З.Э.; Akhaladze G.G.; Goncharov S.V.; Ragimov V.A.; Baliev Z.E.

Научные статьи \ Прикладные науки. Медицина. Технология \ Mедицинские науки \ Патология. Клиническая медицина \ Заболевания пищеварительной системы. Болезнь пищеварительного тракта

Эволюция изменения подходов в хирургии злокачественных новообразований печени

Автор: Ахаладзе Г.Г., Гончаров С.В., Рагимов В.А., Балиев З.Э.

Журнал: Вестник Российского научного центра рентгенорадиологии Минздрава России @vestnik-rncrr

Рубрика: Онкология

Статья в выпуске: 2 т.24, 2024 года.

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Цель: провести обзор современных тенденций в хирургии печени, сопроводив их собственными данными. Методы. Проведен анализ отдаленных результатов лечения больных после резекции печени по поводу метастазов колоректального рака в зависимости от ширины отступа от опухолевого узла, вида выполненной резекции, периода хирургического вмешательства. Проведенный анализ дополнен обзором современных литературных данных по теме анализа. Результаты. Общая медиана наблюдения в группе пациентов с резекциями по поводу метастазов колоректального рака в печень составила 80 месяцев при 95% доверительном интервале [9,7;150,3]. Сравнение общей выживаемости пациентов с краевым отступом до 1 мм и более 1 мм не выявило статистически значимой разницы (p=0,686). Трехлетняя общая выживаемость пациентов с отступом края опухоли до 1 мм составила 66,5±13,9%, а с отступом края опухоли более 1 мм - 70,4±9,1%. Сравнение общей выживаемости периодов наблюдения 2013-2015, 2016-2018 и 2019-2023 гг. не было статистически значимым (p=0,087). Сравнение периодов 2013-2015 гг. с 2016-2023 гг. статистически значимо (p=0,038). Трехлетняя выживаемость пациентов периода 2013-2015 годов составила 37,5±17,1%, периода 2013-2016 годов - 82,5±8,0%, а периода 2019-2023 годов - 70,6±20,8%. Общая выживаемость пациентов с анатомической и атипичной резекцией печени статистически не значима (p=0,965). Трехлетняя выживаемость пациентов с атипичными резекциями составила 67,0±11,6%, а с анатомическими - 76,9±9,3%. Заключение. С внедрением новых направлений в хирургии печени, таких как паренхимасберегающие резекции, минимизация края отступа от опухоли, скелетизация сосудов, внедрение принципа резекции по печеночным венам с максимальной детализацией ориентиров, хирургия печени расширяет свои возможности, охватывая новые когорты пациентов с множественными ранее нерезектабельными опухолями, улучшая непосредственные и отдаленные результаты хирургического лечения.

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Метастазы в печени, колоректальный рак, паренхимасберегающие резекции

Короткий адрес: https://sciup.org/149145579

IDR: 149145579

Evolution of approaches in liver tumor surgery

Purpose: To review current trends in liver surgery, accompanied by our own data. Methods. An analysis of the long-term results of treatment of patients after liver resection for colorectal cancer metastases is presented, depending on the width of indentation from the tumor node, the type of resection performed and the period of surgical intervention. The analysis was supplemented by a review of the modern literature. Results. The overall median follow-up in the group of patients with resections for colorectal cancer metastases to the liver was 80 months with 95% confidence interval [9.7;150.3]. Comparison of overall survival of patients with marginal margin up to 1 mm and greater than 1 mm showed no statistically significant difference (p=0.686). Three-year overall survival of patients with tumor margin indentation up to 1 mm was 66.5±13.9%, and 70.4±9.1% for patients with tumor margin indentation greater than 1 mm. Comparison of overall survival of the 2013-2015, 2016-2018, and 2019-2023 follow-up periods was not statistically significant (p=0.087). Comparison between the 2013-2015 and 2016-2023 periods was statistically significant (p=0.038). The three-year survival rate of patients of the 2013-2015 period was 37.5±17.1%, the 2013-2016 period was 82.5±8.0%, and the 2019-2023 period was 70.6±20.8%. The overall survival of patients with anatomic and atypical liver resection was not statistically significant (p=0.965). The three-year survival rate of patients with atypical resections was 67.0±11.6% and that of patients with anatomic resections was 76.9±9.3%.

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