Cohort Study of the Survival Benefit of Resection for Recurrent Hepatic and/or Pulmonary Metastases After Primary Hepatectomy for Colorectal Metastases
Cohort Study of the Survival Benefit of Resection for Recurrent Hepatic and/or Pulmonary Metastases After Primary Hepatectomy for Colorectal Metastases
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DOI：
10.1097/sla.0b013e3181c9868a
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发表时间：
2010-05-01
影响因子：
9
通讯作者：
Kokudo, Norihiro
中科院分区：
文献类型：
--
作者：
Mise, Yoshihiro;Imamura, Hiroshi;Kokudo, Norihiro
目的：评价首次肝切除治疗结直肠癌肝转移后肝和/或肺复发的切除效果。摘要背景数据：结直肠肝转移首次肝切除后再次切除肝和/或肺复发的生存益处尚不清楚。方法：216例首次肝切除后的患者中有166例复发。98例患者再次行手术切除。结果：166例患者中，单纯肝复发71例，单纯肺复发25例，肝合并肺复发13例，其他脏器复发57例。单纯肝复发60例(85%)，单纯肺复发21例(84%)，肝肺双复发9例(69%)。单纯性肝复发、孤立性肺复发和肝合并肺复发的5年生存率分别为39%、37%和20%。多因素分析显示预后不良的危险比[95%可信区间]：肿瘤复发个数(1.20[1.11~1.29])，肿瘤最大体积(1.26[1.02~1.48])，肺复发(2.36[1.41~3.20])，肝肺复发(4.01[2.86~0.17])。结论：肺或肝合并肺复发患者预后较单纯肝复发患者差。再次切除是唯一有可能治愈的治疗方法。更严格的适应症标准，特别是关于肿瘤结节的数量，可以导致类似的长期结果。
Objective: To evaluate resection for hepatic and/or pulmonary recurrences in a cohort that underwent initial hepatectomy for colorectal liver metastases.Summary Background Data: The survival benefit of repeated resections for hepatic and/or pulmonary recurrences after initial hepatectomy for colorectal liver metastases has remained unclear.Methods: Recurrence occurred in 166 of the 216 patients after the first hepatectomy. Repeated resections were performed in 98 patients. We investigated the pattern of recurrence, the proportion of patients who underwent repeated resection, and the surgical outcome.Results: Of the 166 patients with recurrence, 71 had isolated hepatic recurrence, 25 had isolated pulmonary recurrence, 13 had hepatic plus pulmonary recurrence, and 57 had recurrence in other organs. Repeated resections were conducted in 60 (85%) patients with isolated hepatic recurrence, 21 (84%) with isolated pulmonary recurrence, and 9 (69%) with both hepatic and pulmonary recurrence. The 5-year survival rates after repeated resection were 39%, 37%, and 20% for isolated hepatic recurrence, isolated pulmonary recurrence, and hepatic plus pulmonary recurrence, respectively. Multivariate analysis revealed that the following variables contributed to poor prognosis (hazard ratio [95% confidence interval]): number of recurrent tumors (1.20 [1.11-1.29]), maximum size of recurrent tumors (1.26 [1.02-1.48]), pulmonary recurrence (2.36 [1.41-3.20]), and hepatic plus pulmonary recurrence (4.01 [2.86-.17]).Conclusions: Patients with pulmonary or hepatic plus pulmonary recurrence had poorer prognoses than those with isolated hepatic recurrence. Reresection is the only potentially curative treatment. Stricter indication criteria, especially regarding the number of tumor nodules, can lead to comparable long-term outcomes.