Prognostic factors for poor survival after repeat hepatectomy in patients with colorectal liver metastases
Prognostic factors for poor survival after repeat hepatectomy in patients with colorectal liver metastases
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DOI：
10.1067/msy.2003.151
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发表时间：
2003-06-01
期刊：
影响因子：
3.8
通讯作者：
Kinoshita, T
中科院分区：
文献类型：
--
作者：
Takahashi, S;Inoue, K;Kinoshita, T
背景结直肠肝转移瘤再次肝切除术后复发率高，再次肝切除术的选择标准仍有争议。方法。转移性结肠癌再次肝切除的临床资料。回顾性分析20例原发性肝癌患者的临床资料，并与初次肝切除及其他治疗方法进行比较，以确定再次肝切除的标准，并确定其疗效。对于22例接受重复肝切除术的患者，未观察到死亡率和18%的发病率。再次肝切除后3年生存率为49%。重复肝切除术后唯一的不良预后因素是首次肝切除术前血清癌胚抗原水平大于50 ng/mL。对于初次肝切除术前癌胚抗原水平较高的患者，再次肝切除术的预后与接受全身化疗或肝动脉灌注治疗不能切除的残肝肿瘤的预后大致相同。重复肝切除术治疗结直肠癌肝转移可以安全地进行，似乎是有效的初始肝切除术。然而，对于初次肝切除术前癌胚抗原水平大于50 ng/mL的患者，单独重复肝切除可能不那么有效，需要新的策略。
Background. The recurrence rate for colorectal liver metastases after repeat hepatic resection is high, and selection criteria for repeat hepatectomy are still controversial.Methods. Clinical data of patients undergoing repeat hepatectomy fir metastatic colon cancer. were reviewed retrospectively and compared with those of initial hepatectomy and other treatments to determine criteria for repeat hepatectomy and to confirm its efficacy.Results. For 22 patients who underwent repeat hepatectomy, no mortality and an 18% morbidity rate were observed. The 3-year survival rate after repeat hepatectomy was 49%. The only poor prognostic factor after repeat hepatectomy was a serum carinoembryonic antigen level greater than 50 ng/mL before initial hepatectomy. The prognosis for patients who underwent repeat hepatectomy and had shown high carcinoembryonic antigen levels before initial hepatectomy was approximately equal to that for the patients who received systemic chemotherapy or hepatic arterial infusion for unresectable tumors in the remnant liver.Conclusion. Repeat hebatectomy for colorectal liver metastases can be performed safely and appears to be as effective as initial hepatectomy. However, for Patients with a carcinoembryonic antigen level greater than 50 ng/mL before the initial hepatectomy, repeat hepatic resection alone may not be as effective, and a new strategy is needed.