Liver resection for multiple colorectal metastases - Influence of parenchymal involvement and total tumor volume, vs number or location, on long-term survival
Liver resection for multiple colorectal metastases - Influence of parenchymal involvement and total tumor volume, vs number or location, on long-term survival
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DOI：
10.1001/archsurg.137.10.1187
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发表时间：
2002-10-01
影响因子：
--
通讯作者：
Cavallari, A
中科院分区：
文献类型：
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作者：
Ercolani, G;Grazi, GL;Cavallari, A
假设：多发性和/或双侧肝转移瘤并非手术切除的绝对禁忌症。设计：回顾性分析。设置：大学外科和移植系。患者和干预：共245例结直肠转移瘤的根治性肝切除术分为3组：M1，单一病灶; M2，多发性单叶和M3，多发性双叶。主要结局指标：单因素和多因素分析，使用几个预后因素进行区分变量影响长期survival.Results：总体手术死亡率为0.8%。5年生存率为34%。在多变量分析中，只有肿瘤累及肝脏的百分比对预后有显著影响。通过用肿瘤总体积代替这个变量，后一个变量是生存率的唯一独立预测因子。多发转移且肿瘤总体积小于125 cm（3）的患者的预后明显优于单发结节且肿瘤总体积大于380 cm（3）的患者。M1、M2和M3组的手术死亡率和发病率相当。5年生存率分别为41%、17%和34%（M1组与M2组，P = 0.05; M1组与M3组和M2组与M3组，无显著性差异）。5年生存率分别为41%和23%的患者与单一和多个病灶，分别为35%和32%的患者与unilobar和bilobar lesions.Conclusions：一个更好的结果，在患者与小的单一病变。在多发和/或双侧转移的患者中，通过手术方法获得了可接受的5年生存率上级至20%。转移瘤的总体积，而不是数量和位置，似乎是生存率的最强预测因子。
Hypothesis: Multiple and/or bilateral liver metastases are not absolute contraindications to surgical resection.Design: Retrospective analysis.Setting: University department of surgery and transplantation.Patients and Intervention: A total of 245 curative liver resections for colorectal metastases were divided into 3 groups: M1, single lesions; M2, multiple unilobar, and M3, multiple bilobar.Main Outcome Measures: Univariate and multivariate analysis using several prognostic factors was performed to distinguish variables affecting long-term survival.Results: Overall operative mortality was 0.8%. Overall 5-year survival was 34%. On multivariate analysis, only the percentage of hepatic involvement by the tumor significantly affected prognosis. By replacing this variable with the total tumor volume, this latter variable was the only independent predictor of survival. Patients with multiple metastases and total tumor volume less than 125 cm(3) had a significantly better outcome than patients with single nodules and total tumor volume more than 380 cm(3). Operative mortality and morbidity were comparable among groups M1, M2, and M3. The 5-year survival was 41%, 17%, and 34%, respectively (group M1 vs M2, P = .05; group M1 vs M3 and group M2 vs M3, not significant). The 5-year survival was 41% and 23% in patients with single and multiple lesions, respectively and was 35% and 32% in patients with unilobar and bilobar lesions, respectively.Conclusions: A better outcome in patients with small single lesions was shown. In patients with multiple and/or bilateral metastases, an acceptable 5-year survival superior to 20% was obtained by surgical approach. The total volume of metastases, not number and location, seems to be the strongest predictor of survival.