Survival after hepatic resection for colorectal metastases: A 10-year experience
Survival after hepatic resection for colorectal metastases: A 10-year experience
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DOI：
10.1245/aso.2006.05.039
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发表时间：
2006-05-01
影响因子：
3.7
通讯作者：
Gallinger, S
中科院分区：
文献类型：
--
作者：
Wei, AC;Greig, PD;Gallinger, S
转移性结直肠癌是北美癌症死亡的主要原因。肝切除术为选定的患者提供了治愈的可能。我们报告了一个肝胆外科肿瘤中心10年内因结直肠癌转移而行肝切除术的患者的长期结局，所有1992年至2002年因结直肠癌转移而行肝切除术的患者均被确定。通过病历审查回顾性获得数据。主要结果变量为无病生存期和总生存期。采用考克斯比例风险法对423例转移性结直肠癌行肝切除术患者进行多因素分析。大多数手术（n = 276; 65%）为大（4个或更多节段）肝切除术。74例（17%）患者发生围手术期并发症。有7例（1.6%）围手术期死亡。1年、5年和10年的无病生存率分别为64%、27%和22%。1年、5年和10年的总生存率分别为93%、47%和28%。多变量分析确定了总生存期的四个阴性预测因素（风险比; 95%置信区间）：手术切缘阳性（2.9; 1.5-5.3），大转移（> 5 cm; 1.5; 1.1-2.0），多发转移（1.4; 1.1-1.9），年龄> 60岁（1.4; 1.1-1.9）.肝切除治疗转移性结直肠癌是安全的，5年和10年的长期总生存率分别为47%和28%。积极的方法是合理的低手术死亡率和良好的长期生存率，即使在多个双叶转移的个人。
Metastatic colorectal cancer is a major cause of cancer death in North America. Hepatic resection offers the potential for cure in selected patients. We report the long-term outcomes of patients who underwent hepatic resection for colorectal metastases over a 10-year period at a single hepatobiliary surgical oncology center.All patients who underwent liver resection for metastatic colorectal cancer between 1992 and 2002 were identified. Data were retrospectively obtained through chart review. Major outcome variables were disease-free survival and overall survival. Risk factors for disease recurrence and mortality were identified by multivariate analysis by using the Cox proportional hazard method.A total of 423 hepatectomies were performed for metastatic colorectal cancer. Most operations (n = 276; 65%) were major (four or more segments) hepatectomies. Perioperative morbidity occurred in 74 (17%) patients. There were seven (1.6%) perioperative deaths. The disease-free survival at 1, 5, and 10 years was 64%, 27%, and 22%, respectively. The overall survival at 1, 5, and 10 years was 93%, 47%, and 28%, respectively. Multivariate analysis identified four negative predictive factors for overall survival (hazard ratio; 95% confidence interval): a positive surgical margin (2.9; 1.5-5.3), large metastases (> 5 cm; 1.5; 1.1-2.0), multiple metastases (1.4; 1.1-1.9), and age > 60 years (1.4; 1.1-1.9).Hepatic resection for metastatic colorectal cancer is safe and provides good long-term overall survival rates of 47% at 5 years and 28% at 10 years. An aggressive approach is justified by the low operative mortality rate and good long-term survival, even in individuals with multiple bilobar metastases.