Repeat hepatectomy for colorectal liver metastases
Repeat hepatectomy for colorectal liver metastases
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DOI：
10.1097/00000658-199701000-00006
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发表时间：
1997-01-01
影响因子：
9
通讯作者：
Engerran, L
中科院分区：
文献类型：
--
作者：
Adam, R;Bismuth, H;Engerran, L
目的作者评估长期的结果重复肝切除术的复发转移的结直肠癌和确定的因素，可以预测survival.Summary背景数据更安全的技术肝切除术允许外科医生考虑重复肝切除术结直肠癌转移的患者越来越多。然而，更高的手术出血和发病率增加后，重复肝切除术的报道，这些程序的长期效益需要evaluated.Study人群64例患者从一组243例结直肠癌肝转移切除术提交了83废除肝切除术（64第二，15第三和4第四肝切除术）。83例再次肝切除术中21例（25%）行联合肝外手术。与第一次切除术相比，重复肝切除术的手术出血没有显著增加。死亡率和住院时间与首次肝切除术相当。第二次肝切除术后的总生存率和无病生存率在3年时分别为60%和42%，在5年时分别为41%和26%。单因素分析的预后价值的因素包括第一次和第二次肝切除术的治愈性质（分别为p=0.04和p=0.002）、两次手术之间的间隔超过1年（p=0.003）、复发肿瘤的数量（p=0.002）、血清癌胚抗原水平（p=0.03）和肝外疾病的存在（p=0.03）。只有治愈性的第二次肝切除术和两个程序之间的间隔超过1年的独立相关的生存多变量analysis.Conclusions重复肝切除术可以提供长期生存率类似的第一次肝切除术，没有死亡率和可比的发病率。可能需要联合肝外手术来实现肿瘤根除。重复肝切除术似乎值得潜在的治愈。
Objective The authors assess the long-term results of repeat hepatectomies for recurrent metastases of colorectal cancer and determine the factors that can predict survival.Summary Background Data Safer techniques of hepatic resection have allowed surgeons to consider repeat hepatectomy for colorectal metastases in an increasing number of patients. However, higher operative bleeding and increased morbidity have been reported after repeat hepatectomies, and the long-term benefit of these procedures needs to be evaluated.Study Population Sixty-four patients from a group of 243 patients resected for colorectal liver metastases were submitted to 83 repeal hepatectomies (64 second, 15 third, and 4 fourth hepatectomies). Combined extrahepatic surgery was performed in 21 (25%) of these 83 repeat hepatectomies.Results There was no intraoperative or postoperative mortality. Operative bleeding was not significantly increased in repeat hepatectomies as compared to first resections. Morbidity and duration of hospital stay were comparable to first hepatectomies. Overall and disease-free survival after a second hepatectomy were 60% and 42%, respectively, at 3 years and 41% and 26%, respectively, at 5 years. Factors of prognostic value on univariate analysis included the curative nature of first and second hepatectomies (p=0.04 and p=0.002, respectively), an interval between the two procedures of more than 1 year (p=0.003), the number of recurrent tumors (p=0.002), serum carcinoembryonic antigen levels (p=0.03), and the presence of extrahepatic disease (p=0.03). Only the curative nature of the second hepatectomy and an interval of more than 1 year between the two procedures were independently related to survival on multivariate analysis.Conclusions Repeat hepatectomies can provide long-term survival rates similar to those of first hepatectomies, with no mortality and comparable morbidity. Combined extrahepatic surgery can be required to achieve tumor eradication. Repeat hepatectomies appear worthwhile when potentially curative.