Surgical treatment of hepatic caudate lobe metastases originating from colorectal primaries.
Surgical treatment of hepatic caudate lobe metastases originating from colorectal primaries.
复制标题
源自结直肠原发灶的肝尾状叶转移瘤的手术治疗。
作者：
T. Tono;H. Ohzato;M. Fukunaga;Y. Hasuike;H. Nakagawa;T. Monden;J. Okamura;N. Kikkawa;Y. Takatsuka
肝尾状叶恶性肿瘤切除术近来受到关注。然而，关于结直肠癌尾状叶转移性肝肿瘤的报道较少，其临床特点尚不清楚。本文对我所手术治疗的3例患者和文献报道的15例病例进行分析，以揭示该病的临床特征。许多患者在手术时已经是晚期肝脏肿瘤，如侵犯主要血管。8例行孤立性尾状叶全切除术，6例行肝大部切除术。7例同时行下腔静脉部分切除术。在11例患者中观察到疾病复发：7例仅在残留肝脏中复发，其中5例接受了另一次肝切除术。死亡病例中位生存时间为25个月，7例下腔静脉切除者中位生存时间为18个月。接受第二次肝切除术的五名患者中有两名存活超过90个月。提示积极的外科治疗包括反复肝切除可延长生存期。早期诊断和在更适当的疾病阶段进行手术治疗可能会进一步提高生存率。
Malignant tumor resection of the hepatic caudate lobe has recently received attention. However, there are few reports about metastatic liver tumor in the caudate lobe from colorectal carcinoma, and its clinical features still remain unknown. In this paper, three patients operated on in our institute and 15 reported cases from the published literature were analyzed in order to reveal clinical features of this disease. Many cases had advanced liver tumors, such as invasion in to major vessels at the time of operation. Isolated complete caudate lobectomy was performed in 8 patients and major hepatectomy was carried out in 6 instances. Seven cases also underwent partial resection of the inferior vena cava. Recurrence of disease was observed in 11 patients: seven cases had relapse only in the residual liver, five of whom underwent another hepatectomy. The median survival time of those patients who died was 25 months, and that of seven cases with IVC resection, 18 months. Two patients out of five who received a second hepatectomy survived for longer than 90 months. It is suggested that aggressive surgical treatment including repeated hepatectomy results in the prolongation of survival. Earlier diagnosis and surgical treatment at a more appropriate stage of the disease may further improve the survival rate.