Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases
Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases
复制标题
DOI：
10.1016/j.jamcollsurg.2007.04.039
复制
发表时间：
2007-08-01
影响因子：
5.2
通讯作者：
DeMatteo, Ronald P.
中科院分区：
文献类型：
--
作者：
Miller, George;Biernacki, Peter;DeMatteo, Ronald P.
背景：手术切除孤立性肝或肺结直肠转移瘤可提高选定患者的生存率。但是，切除术的好处和适当的选择标准，在患者谁开发的肝和肺转移是不明确的。研究设计：数据前瞻性收集131例结直肠癌谁接受切除的肝和肺转移超过20年的时间。从原发性肿瘤切除开始的中位随访时间为6.6年。患者，治疗和结果变量进行了分析，采用对数秩，考克斯回归，Kaplan-Meier methods.Results：首次转移的网站是在65%的患者的肝脏，肺在11%，和两者同时在24%。51%的患者存在多发性肝转移，48%的患者存在多发性肺转移。61%的患者需要行肝叶切除术或三叶切除术;大多数肺转移瘤（80%）采用楔形切除术治疗。原发灶、第一个转移灶和第二个转移灶切除后的中位生存率分别为6.9、5.0和3.3年。在第二个转移部位切除病灶后，1、3、5和10年疾病特异性生存率分别为91%、55%、31%和19%。预后因素的分析表明，生存期显着延长时，无病的第一和第二个网站的转移超过1年的发展之间的间隔，在一个单一的肝转移的患者，并在患者年龄小于55岁。结论：手术切除肝和肺结直肠转移与选定的患者的生存期延长。转移灶之间无病间隔较长的患者和单肝病灶患者的结局最好。
BACKGROUND: Surgical resection of isolated hepatic or pulmonary colorectal metastases prolongs survival in selected patients. But the benefits of resection and appropriate selection criteria in patients who develop both hepatic and pulmonary metastases are ill defined.STUDY DESIGN: Data were prospectively collected from 131 patients with colorectal cancer who underwent resection of both hepatic and pulmonary metastases over a 20-year period. Median followup was 6.6 years from the time of resection of the primary tumor. Patient, treatment, and outcomes variables were analyzed using log-rank, Cox regression, and Kaplan-Meier methods.RESULTS: The site of first metastasis was the liver in 65% of patients, the lung in 11%, and both simultaneously in 24%. Multiple hepatic metastases were present in 51% of patients, and multiple pulmonary metastases were found in 48%. Hepatic lobectomy or trisegmentectomy was required in 61% of patients; most lung metastases (80%) were treated with wedge excisions. Median survival rates from resection of the primary disease, first site of metastasis, and second site of metastasis were 6.9, 5.0, and 3.3 years, respectively. After resection of disease at the second site of metastasis, the 1-, 3-, 5-, and 10-year disease-specific survival rates were 91%, 55%, 31%, and 19%, respectively. An analysis of prognostic factors revealed that survival was significantly longer when the disease-free interval between the development of the first and second sites of metastases exceeded 1 year, in patients with a single liver metastasis, and in patients younger than 55 years old.CONCLUSIONS: Surgical resection of both hepatic and pulmonary colorectal metastases is associated with prolonged survival in selected patients. Patients with a longer disease-free interval between metastases and those with single liver lesions had the best outcomes.