Hepatic resection for metastatic tumors from gastric cancer
Hepatic resection for metastatic tumors from gastric cancer
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DOI：
10.1097/00000658-200201000-00011
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发表时间：
2002-01-01
影响因子：
9
通讯作者：
Maeta, H
中科院分区：
文献类型：
--
作者：
Okano, K;Maeba, T;Maeta, H
目的探讨胃腺癌肝转移的手术疗效和临床病理特点，以提高患者的生存概率。摘要背景资料许多研究报道了肝切除治疗结直肠癌肝转移的益处，但对累及肝脏的胃腺癌的手术指征尚未明确。方法807例原发胃癌患者中，90例(11%)同时(n=78)或(n=12)异时(n=12)肝转移。其中19人接受了20次切除，旨在治愈肝脏转移灶。结果肝切除术后1年、3年、5年生存率分别为77%、34%、34%，其中3例术后存活5年以上。孤立性和异时性转移是肝切除后良好预后的重要决定因素。病理上，19例患者中有13例(68%)在肿瘤与周围肝实质之间发现纤维性假包膜。肿瘤周围纤维性假囊的存在和分化良好的转移性结节是重要的预后因素。与原发灶相关的因素对接受根治性切除的患者的预后影响不大。结论胃癌单发和异时转移应采用手术治疗，预后较好，假囊的存在可能有助于明确术后辅助治疗的适应证。
Objective To assess the surgical results and clinicopathologic features of hepatic metastases from gastric adenocarcinoma to identify patients with a better probability of survival.Summary Background Data Many studies have reported the benefit of hepatic resection for metastatic tumors from colorectal cancer, However, indications for a surgical approach for gastric adenocarcinoma involving the liver have not been clearly defined.Methods Ninety (11 %) of 807 patients with primary gastric cancer were diagnosed with synchronous (n = 78) or metachronous (n 12) hepatic metastases. Of these, 19 underwent 20 resections intended to cure the metastatic lesion in the liver. The clinicopathologic features of the hepatic metastases in, and the surgical results for, the 19 patients were analyzed.Results The actuarial 1 -year, 3-year, and 5-year survival rates after hepatic resection were, respectively, 77%, 34%, and 34%, and three patients survived for more than 5 years after surgery. Solitary and metachronous metastases were significant determinants for a favorable prognosis after hepatic resect ion. Pathologically, a fibrous pseudocapsule between the tumor and surrounding hepatic parenchyma was found in 13 of the 19 patients (68%). The presence of a peritumoral fibrous pseudocapsule and a well -differentiated histologic type of metastatic nodule were significant prognostic factors. Factors associated with the primary lesion were not significant prognostic determinants in patients who underwent curative resection of the primary cancer.Conclusions Solitary and metachronous metastases from gastric cancer should be treated by a surgical approach and confer a better prognosis, A new prognostic factor, the presence of a pseudocapsule, may be helpful in defining indications for postoperative adjuvant treatment.