(1) Background: Despite advances in surgical technique and systemic chemotherapy, some patients with multifocal, bilobar colorectal liver metastases (CRLM) remain unresectable. These patients may benefit from surgical debulking of liver tumors in combination with chemotherapy compared to chemotherapy alone. (2) Methods: A retrospective study including patients evaluated for curative intent resection of CRLM was performed. Patients were divided into three groups: those who underwent liver resection with recurrence within 6 months (subtotal debulked, SD), those who had the first stage only of a two-stage hepatectomy (partially debulked, PD), and those never debulked (ND). Kaplan–Meier survival curves and log-rank test were performed to assess the median survival of each group. (3) Results: 174 patients underwent liver resection, and 34 patients recurred within 6 months. Of the patients planned for two-stage hepatectomy, 35 underwent the first stage only. Thirty-two patients were never resected. Median survival of the SD, PD, and ND groups was 31 months, 31 months, and 19.5 months, respectively (p= 0.012); (4) Conclusions: Patients who underwent a debulking of CRLM demonstrated a survival benefit compared to patients who did not undergo any surgical resection. This study provides support for the evaluation of intentional debulking versus palliative chemotherapy alone in a randomized trial.
(1) 背景：尽管外科技术和全身化疗取得进展，部分多灶性、双叶分布的结直肠癌肝转移（CRLM）患者仍无法切除。与单纯化疗相比，这些患者可能从肝脏肿瘤减瘤手术联合化疗中获益。(2) 方法：本研究回顾性纳入以根治为目的评估CRLM切除的患者。将患者分为三组：接受肝切除术后6个月内复发者（次全减瘤组，SD）、仅完成两阶段肝切除术第一阶段者（部分减瘤组，PD）以及从未接受减瘤手术者（未减瘤组，ND）。采用Kaplan-Meier生存曲线和对数秩检验评估各组中位生存期。(3) 结果：174例患者接受肝切除术，其中34例在6个月内复发。计划行两阶段肝切除术的患者中，35例仅完成第一阶段。32例患者从未接受切除。SD组、PD组和ND组的中位生存期分别为31个月、31个月和19.5个月（p=0.012）。(4) 结论：接受CRLM减瘤手术的患者相较于未接受任何手术切除的患者显示出生存获益。本研究为在随机试验中评估意向性减瘤手术与单纯姑息化疗的疗效提供了依据。
Debulking Hepatectomy for Colorectal Liver Metastasis Conveys Survival Benefit
肿瘤(癌症)患者之家