大肠癌肝转移的双扇区肝脏转移对于获得令人满意的肿瘤学结果和合适的未来肝组织残留量构成挑战。本研究旨在评估手术清除大肠癌肝转移的双扇区肝脏转移患者的临床和病理决定因素，包括总体生存和无复发生存。进行了一项回顾性的国际多中心研究，纳入了2012年1月至2018年12月间接受大肠癌肝转移双扇区肝脏转移手术的患者。主要评估指标为手术后1、2、3和5年的总体生存和无复发生存率。次要指标为术后住院时间、90天重大并发症和死亡率。利用Cox比例风险回归模型选择的共变量构建了预后预测模型，并使用3:1的随机划分将其在推导集和验证集上进行内部验证。共纳入了来自70个中心的1236名患者。大多数患者（88%）具有同步肝转移。手术后1、2、3和5年的总体生存率分别为86.4%、67.5%、52.6%和33.8%，无复发生存率分别为48.7%、26.6%、19.2%和10.5%。25%的患者在术后6个月内出现复发疾病。切缘阳性和肝切除时进展性疾病是不良预后因素，切缘阳性切除术中的辅助化疗改善了总体生存率。双扇区肝转移原发大肠癌患者总体生存预测模型基于术前和术后因素在推导集上构建，随后在验证集上验证，具有较高的准确性（总体C指数=0.742）。尽管复发率较高，但接受手术切除双扇区肝转移的患者总体生存状况令人鼓舞。新颖的双扇区肝转移原发大肠癌总体生存预测模型有助于为计划治疗双扇区肝转移原发大肠癌的患者提供咨询和决策支持。 ©作者2023年。由牛津大学出版社代表BJS学会出版。

Bilobar liver metastases from colorectal cancer pose a challenge for obtaining a satisfactory oncological outcome with an adequate future liver remnant. This study aimed to assess the clinical and pathological determinants of overall survival and recurrence-free survival among patients undergoing surgical clearance of bilobar liver metastases from colorectal cancer.A retrospective international multicentre study of patients who underwent surgery for bilobar liver metastases from colorectal cancer between January 2012 and December 2018 was conducted. Overall survival and recurrence-free survival at 1, 2, 3 and 5 years after surgery were the primary outcomes evaluated. The secondary outcomes were duration of postoperative hospital stay, and 90-day major morbidity and mortality rates. A prognostic nomogram was developed using covariates selected from a Cox proportional hazards regression model, and internally validated using a 3:1 random partition into derivation and validation cohorts.A total of 1236 patients were included from 70 centres. The majority (88 per cent) of the patients had synchronous liver metastases. Overall survival at 1, 2, 3 and 5 years was 86.4 per cent, 67.5 per cent, 52.6 per cent and 33.8 per cent, and the recurrence-free survival rates were 48.7 per cent, 26.6 per cent, 19.2 per cent and 10.5 per cent respectively. A total of 25 per cent of patients had recurrent disease within 6 months. Margin positivity and progressive disease at liver resection were poor prognostic factors, while adjuvant chemotherapy in margin-positive resections improved overall survival. The bilobar liver metastases from colorectal cancer-overall survival nomogram was developed from the derivation cohort based on pre- and postoperative factors. The nomogram's ability to forecast overall survival at 1, 2, 3 and 5 years was subsequently validated on the validation cohort and showed high accuracy (overall C-index = 0.742).Despite the high recurrence rates, overall survival of patients undergoing surgical resection for bilobar liver metastases from colorectal cancer is encouraging. The novel bilobar liver metastases from colorectal cancer-overall survival nomogram helps in counselling and informed decision-making of patients planned for treatment of bilobar liver metastases from colorectal cancer.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.