Surgical margin in hepatic resection for colorectal metastasis - A critical and improvable determinant of outcome
Surgical margin in hepatic resection for colorectal metastasis - A critical and improvable determinant of outcome
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DOI：
10.1097/00000658-199804000-00019
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发表时间：
1998-04-01
影响因子：
9
通讯作者：
Linehan, DC
中科院分区：
文献类型：
--
作者：
Cady, B;Jenkins, RL;Linehan, DC
目的更新大型单机构系列中与结直肠转移肝切除术相关的技术和生物学因素的分析，以确定重要的预后指标和失败模式。背景数据摘要手术治疗转移至肝脏的结直肠癌是唯一可能治愈的治疗方法。仔细选择可切除的仅肝脏转移性疾病患者对于手术治疗的成功至关重要。方法对连续244例因转移性结直肠癌接受根治性肝切除术的患者进行回顾性分析。检查的变量包括性别、原发病变阶段、肝脏病变大小、病变数量、无病间隔、倍性、分化；术前癌胚抗原水平以及手术因素，如切缘、冷冻疗法的使用、术中超声和失血量。结果手术切缘、病灶数量和癌胚抗原（CEA）水平显着控制预后。仅一到两个肝脏病变、手术切缘为 1 cm、CEA 水平较低的患者，5 年无病生存率超过 30%。无病间隔、原始分期、双叶受累、转移大小、分化和倍性并不是复发的显着预测因素。失败的模式与手术切缘相关。常规使用术中超声导致检查期间阴性手术切缘的发生率增加。结论对于适当选择的患者，结直肠癌肝转移的手术切除或冷冻疗法是安全且可治愈的。生物学因素，例如病变数量和癌胚抗原水平，决定了潜在的治愈性，而手术切缘决定了潜在可治愈患者的失败模式和结果。优化选择标准和手术切除边缘将改善结果。
ObjectiveTo update the analysis of technical and biologic factors related to hepatic resection for colorectal metastasis ina large single-institution series to identify important prognostic indicators and patterns of failure.Summary Background DataSurgical therapy for colorectal carcinoma metastatic to the liver is the only potentially curable treatment. Careful patient selection of those with resectable liver-only metastatic disease is crucial to the success of surgical therapy.MethodsTwo hundred forty-four consecutive patients undergoing curative hepatic resection for metastatic colorectal carcinoma were analyzed retrospectively. Variables examined included sex, stage of primary lesion, size of liver lesion(s), number of lesions, disease-free interval, ploidy, differentiation; preoperative carcinoembryonic antigen level, and operative factors such as resection margin, use of cryotherapy, intraoperative ultrasound, and blood loss.ResultsSurgical margin, number of lesions, and carcinoembryonic antigen (CEA) levels significantly control prognosis. Patients with only one or two liver lesions, a 1-cm surgical margin, and low CEA levels have a 5-year disease-free survival rate of more than 30%. Disease-free interval, original stage, bilobar involvement, size of metastasis, differentiation, and ploidy were not significant predictors of recurrence. The pattern of failure correlates with surgical margin. Routine use of intraoperative ultrasound resulted in an increased incidence of negative surgical margin during the period examined.ConclusionsSurgical resection or cryotherapy of hepatic metastasis from colorectal cancer is safe and curable in appropriately selected patients. Biologic factors, such as number of lesions and carcinoembryonic antigen levels, determine potential curability, and surgical margin governs the patterns of failure and outcome in potentially curable patients. Optimization of selection criteria and surgical resection margins will improve outcome.