Hepatic resection with reconstruction of the inferior vena cava or hepatic venous confluence for metastatic liver tumor from colorectal cancer
Hepatic resection with reconstruction of the inferior vena cava or hepatic venous confluence for metastatic liver tumor from colorectal cancer
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DOI：
10.1016/j.jamcollsurg.2003.11.004
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发表时间：
2004-03-01
影响因子：
5.2
通讯作者：
Makuuchi, M
中科院分区：
文献类型：
--
作者：
Aoki, T;Sugawara, Y;Makuuchi, M
背景：切除浸润下腔静脉（lVC）或肝静脉汇合处（HVC）的结直肠肝转移瘤在技术上是可行的，但该手术通常涉及侵入性技术，其长期结果尚未得到充分描述。研究设计：从1994年10月到2001年6月，87例结直肠癌转移患者接受了首次治愈性肝切除术。9例患者（IVC/HVC组）接受肝切除术合并IVC或HVC重建。调查临床病理特征、手术结果和患者生存率，并与其余78例患者（对照组）进行比较。结果：成功切除3条IVCs和8条肝静脉，并通过一期闭合（n = 3）、直接吻合（n = U）或自体静脉移植（n = 7）重建肝静脉。两组之间的比较显示，原发性结直肠肿瘤分期相似，但lVC/HVC组有更多（中位4比2，p < 0.05）和更大（中位5.0比3.2 cm, p < 0.05）病变。IVC/HVC组需要更长的手术时间（中位600 vs 320分钟，p < 0.001），出血量更大（中位1034 vs 434 g， p < 0.01），更广泛的肝实质切除（中位585 vs 155 g， p < 0.001）。lVC/HVC组患者生存时间较短（中位生存时间25.8个月比44.0个月，p < 0.01）。结论：肝切除联合下腔静脉或HVC重建治疗结直肠肝转移可以获得可接受的发病率，并且可能没有死亡率。虽然从我们的研究中无法得出长期生存的明确结论，但鉴于患者数量有限，他们的总体生存并不令人满意。由于手术切除目前是治愈的唯一希望，因此需要进一步的研究来阐明lVC/HVC联合切除和重建对长期生存的贡献。(C) 2004年由美国外科医师学会颁发。
BACKGROUND: Resection of colorectal liver metastases infiltrating the inferior vena cava (lVC) or hepatic venous confluence (HVC) is technically feasible, but the procedure frequently involves invasive techniques, and its long-term outcome has not yet been fully described.STUDY DESIGN: From October 1994 through June 2001, 87 patients underwent first curative hepatic resections for colorectal metastases. Nine patients (the IVC/HVC group) received hepatectomy combined with IVC or HVC reconstruction. Clinicopathologic characteristics, surgical results, and patient survival were investigated and compared with those of the remaining 78 patients (the comparison group).RESULTS: Three IVCs and eight hepatic veins were successfully resected and reconstructed by primary closure (n = 3), direct anastomosis (n = U, or by the use of autologous vein grafts (n = 7). A comparison between the two groups revealed that the primary colorectal tumor stage was similar, but the lVC/HVC group had more (median 4 versus 2, p < 0.05) and larger (median 5.0 versus 3.2 cm, p < 0.05) lesions. The IVC/HVC group required longer operating times (median 600 versus 320 minutes, p < 0.001) and suffered greater blood loss (median 1,034 versus 434 g, p < 0.01) and more extensive liver parenchyma resection (median 585 versus 155 g, p < 0.001). Patients in the lVC/HVC group had a shorter survival time (median survival time 25.8 versus 44.0 months, p < 0.01).CONCLUSIONS: Hepatic resection combined with the IVC or HVC reconstruction for colorectal liver metastases can be performed with acceptable morbidity, and possibly with no mortality. Although no definite conclusion on long-term survival can be drawn from our study, given the limited number of patients, their overall survival was unsatisfactory. Further studies are needed to clarify the contribution of combined resection and reconstruction of lVC/HVC to long-term survival, because surgical resection currently provides the only hope of cure. (C) 2004 by the American College of Surgeons.