Surgical Experience with Hepatic Colorectal Metastasis
Surgical Experience with Hepatic Colorectal Metastasis
复制标题
肝结直肠转移瘤的手术经验
DOI：
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
C. Pinson
中科院分区：
文献类型：
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作者：
A. L. Bradley;W. Chapman;J. K. Wright;J. W. Marsh;S. Geevarghese;K. Blair;C. Pinson
研究了 134 名因结直肠转移而接受肝切除术的患者的结果。目前对 98% 的患者进行了随访，其中 58 名患者的随访时间超过 5 年，总计 360 个患者年。患者（52% 为男性）的平均年龄为 62 ± 1 岁（平均值的标准误差）。初次结肠手术和肝切除术之间的时间间隔中位数为 16 个月，平均为 19 ± 1 个月。 32 例 (24%) 在 6 个月内因原发肿瘤和肝转移而接受了手术。重症监护病房和总住院时间的中位数分别为 1 天和 7 天。病理报告显示，平均有2.0±0.1个病变，最大的病变为4.4±0.2厘米。 72% 的患者仅在一侧肺叶发现病变。 83% 的患者术前 CEA 升高，肝切除前为 60 ± 11 ng/mL，肝切除后为 4.0 ± 0.5 ng/mL。患者 1 年生存率为 81%，3 年生存率为 50%，5 年生存率为 36%，10 年生存率为 23%。实际 5 年和 10 年生存率分别为 58 名患者中的 22 名 (38%) 和 21 名患者中的 4 名 (19%)。 1 年无病生存率为 58%，3 年无病生存率为 27%，5 年无病生存率为 16%，7 年无病生存率为 12%。一到四个病灶的生存率比五个或更多病灶的生存率要好得多（P < 0.01）。其他几个潜在的危险因素并不影响生存，包括患者在肝切除后是否接受化疗。有 36 名 (43%) 患者复发仅伴有肝脏受累，其中 27 名 (32%) 患者出现肝脏受累，21 名 (25%) 患者仅出现非肝脏受累。有 15 名患者继续接受重复肝切除术，5 年生存率为 74%，无病生存率为 58%。对于选定的孤立性肝转移患者，肝切除术提供了任何形式治疗的最佳结果。
The outcome of 134 patients undergoing hepatic resection for colorectal metastasis was studied. Current follow-up was available in 98 per cent of patients, for more than 5 years in 58 patients, and totaling 360 patient-years. Patients (52% male) had an average age of 62 ± 1 years (standard error of the mean). Time lapse between the primary colon surgery and hepatic resection was a median of 16 months and a mean of 19 ± 1 months. Thirty-two (24%) were operated on within 6 months for both their primary tumor and hepatic metastasis. Intensive care unit and total hospital length of stay were a median of 1 and 7 days, respectively. Pathology reports demonstrated that on average there were 2.0 ± 0.1 lesions, with the largest lesion measuring 4.4 ± 0.2 cm. In 72 per cent of patients, the lesions were found in one lobe only. CEA was elevated in 83 per cent of patients preoperatively and was 60 ± 11 ng/mL before and 4.0 ± 0.5 ng/mL after hepatic resection. Patient survival was 81 per cent at 1 year, 50 per cent at 3 years, 36 per cent at 5 years, and 23 per cent at 10 years. Actual 5- and 10-year survival was 22 of 58 (38%) patients and 4 of 21 (19%) patients respectively. Disease-free survival was 58 per cent at 1 year, 27 per cent at 3 years, 16 per cent at 5 years, and 12 per cent at 7 years. Survival was much better for one to four lesions than for five or more lesions (P < 0.01). Several other potential risk factors did not affect survival, including whether the patient received chemotherapy after hepatic resection. There were 36 (43%) patients who recurred with hepatic involvement only, 27 (32%) including hepatic involvement and 21 (25%) with nonhepatic involvement only. There were 15 patients who went on to receive repeat hepatic resections, with a 5-year survival of 74 per cent and disease-free survival of 58 per cent. Hepatic resection provides the best outcome of any form of therapy for selected patients with isolated hepatic metastasis.
DOI：
10.1001/jama.1993.03510080047030
发表时间：
1993-08
期刊：
JAMA
影响因子：
--
作者：
C. Moertel;T. Fleming;J. Macdonald;D. Haller;J. Laurie;C. Tangen
通讯作者：
C. Moertel;T. Fleming;J. Macdonald;D. Haller;J. Laurie;C. Tangen
影响因子：
9
作者：
Graham, RA;Wang, S;Haller, DG
通讯作者：
Haller, DG