IMPROVED SURVIVAL AFTER RESECTION OF COLORECTAL LIVER METASTASES
IMPROVED SURVIVAL AFTER RESECTION OF COLORECTAL LIVER METASTASES
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DOI：
10.1007/bf02307088
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发表时间：
1995-11-01
影响因子：
3.7
通讯作者：
ROH, MS
中科院分区：
文献类型：
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作者：
FUHRMAN, GM;CURLEY, SA;ROH, MS
背景：本研究的目的是确定术中超声(IOUS)分期、评估肝门淋巴结和评估切除范围是否能改善结直肠癌肝转移切除患者的选择。方法：对接受剖腹手术切除结直肠癌肝转移的患者进行回顾性评估。如果通过腹膜探查发现肝外疾病，或IOU显示病变大于4个或无法获得阴性切缘，则患者被认为无法切除。肿瘤阴性切缘经病理检查证实。采用Kaplan和Meier方法计算5年生存率。结果：中位随访时间为25个月。151例接受手术探查的患者中，107例(71.0%)接受了肝切除术(边缘肿瘤均为阴性)。本组手术死亡3例(2.8%)。30例(19.8%)因累及肝外被认为不能切除，14例(9.2%)经IOUS证实不能切除。5年精算生存率：切除组为44%，不能切除组为0(p<；0.0001)。结论：借条、门脉结节评估和病理切缘评估有助于选择可能受益于结直肠癌肝转移切除的患者。
Background: The goal of this study was to determine if staging with intraoperative ultrasound (IOUS), assessment of porta hepatis lymph nodes, and evaluation of resection margins can improve selection of patients likely to benefit from resection of colorectal liver metastases.Methods: A retrospective evaluation was performed on patients undergoing celiotomy with intent to resect colorectal liver metastases. Patients were considered unresectable if extrahepatic disease was identified by peritoneal exploration or if IOUS demonstated greater than four lesions or the inability to achieve negative margins. Tumor-negative margins were confirmed by pathologic evaluation. Actuarial 5-year survival was calculated using the method of Kaplan and Meier.Results: Median follow-up is 25 months. Of the 151 patients undergoing operative exploration, 107 (71.0%) underwent liver resection (all margins tumor negative). Three operative deaths occurred in this group (2.8%). The disease of 30 patients (19.8%) was considered unresectable due to extrahepatic involvement, and that of 14 patients (9.2%) was demonstrated by IOUS to be unresectable. Five-year actuarial survival was 44% for the resected group and 0% for the unresectable patients (p < 0.0001).Conclusions: IOUS, portal node assessment, and pathologic margin evaluation improves the selection of patients likely to benefit from resection of colorectal liver metastases.