Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy
Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy
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DOI：
10.1245/s10434-006-9068-y
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发表时间：
2007-03-01
影响因子：
3.7
通讯作者：
D'Angelica, Michael
中科院分区：
文献类型：
--
作者：
Kornprat, Peter;Jarnagin, William R.;D'Angelica, Michael
背景资料：对于局限于肝脏的结直肠癌转移患者，肝切除通常被认为是唯一可能获得长期生存的方法。尽管一个未知的好处，肝切除术正在发挥越来越大的作用，在广泛的diseases.Methods患者：前瞻性的肝胆外科数据库进行了回顾性分析。结果：在1998年和2002年之间，共584例患者，98例（17%）与四个或更多的结直肠肝转移瘤切除术后，结直肠肝转移癌进行了review.Results。整个组的5年生存率为33%，实际5年生存率为7。无围手术期死亡，围手术期并发症发生率为28%。切缘阳性和肝外病变切除与不良预后独立相关。中位无病生存期为12个月，5年时无精算无病生存者。复发模式，对新辅助化疗的反应，复发时间，复发性疾病切除术也与outcome.Conclusions：切除多个结直肠转移瘤后可以实现长期生存，但是，因为大多数患者会经历疾病复发，有效的辅助治疗和密切的随访是必要的。
Background: Hepatic resection is generally accepted as the only potential for long-term survival in patients with colorectal metastases confined to the liver. Despite an unknown benefit, hepatic resection is playing an increasing role in patients with extensive disease.Methods: A retrospective review of a prospectively maintained hepatobiliary surgical database was carried out. Outcome after hepatectomy for four or more colorectal hepatic metastases was reviewed.Results: Between 1998 and 2002, out of a total of 584 patients, 98 (17%) with four or more colorectal hepatic metastases were resected. Actuarial 5-year survival was 33% for the entire group, with seven actual 5-year survivors. There were no perioperative deaths, and the perioperative morbidity was 28%. Positive margins and extrahepatic disease resection were independently associated with poor outcome. The median disease-free survival was 12 months, with no actuarial disease-free survivors at 5 years. Recurrence pattern, response to neoadjuvant chemotherapy, time to recurrence, and resection of recurrent disease were also associated with outcome.Conclusions: Long-term survival can be achieved after resection of multiple colorectal metastases; however, because most patients will experience recurrence of disease, effective adjuvant therapy and close follow-up is necessary.