Liver Resection for Metastatic Colorectal Cancer in Patients with Concurrent Extrahepatic Disease: Results in 127 Patients Treated at a Single Center
Liver Resection for Metastatic Colorectal Cancer in Patients with Concurrent Extrahepatic Disease: Results in 127 Patients Treated at a Single Center
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DOI：
10.1245/s10434-009-0521-6
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发表时间：
2009-08-01
影响因子：
3.7
通讯作者：
D'Angelica, Michael
中科院分区：
文献类型：
--
作者：
Carpizo, Darren R.;Are, Chandrakanth;D'Angelica, Michael
肝和肝外（EHD）结肠直肠癌转移的手术切除是有争议的。我们分析了我们对合并EHD患者进行肝切除术的经验。目的是描述生存率、复发率和与结果相关的因素。1992年至2007年，1369例患者行肝结直肠转移灶切除术，其中127例（9%）同时行EHD切除术。比较EHD患者和非EHD患者的生存率和复发率。生存数据按转移部位分层。对可能与生存率相关的变量进行单因素和多因素分析。中位随访时间为24个月（3-152个月）。合并EHD患者的3年和5年生存率分别为47%和26%，而无EHD患者的3年和5年生存率分别为67%和49% （P < 0.001）。在EHD患者中，多因素分析发现较高的临床风险评分、全部EHD切除不全、术中发现EHD、接受新辅助化疗与较差的生存期独立相关。门静脉淋巴结转移患者的生存率低于肺或卵巢转移患者。在完全切除所有疾病的患者中，95%复发。在精心挑选的患者中，同时切除肝脏和EHD与长期生存的可能性相关。局限性和可切除的EHD的存在不应该是切除的绝对禁忌症。必须考虑EHD的发生部位和几乎普遍的复发率。
Surgical resection for patients with hepatic and extrahepatic (EHD) colorectal metastases is controversial. We analyzed our experience with hepatic resection in patients with concomitant EHD. The aims were to characterize survival, recurrence rates, and factors associated with outcome.From 1992 to 2007, 1,369 patients underwent resection of hepatic colorectal metastases, of whom 127 (9%) had concurrent resection of EHD. Survival and recurrence were compared between patients with and without EHD. Survival data were stratified by site of metastatic involvement. Variables potentially associated with survival were analyzed in univariate and multivariate analyses.Median follow-up was 24 months (range 3-152 months). The 3- and 5-year survival for patients with concomitant EHD were 47% and 26%, respectively, compared with 67% and 49%, for those without EHD (P < 0.001). Among the patients with EHD, multivariate analysis identified higher clinical risk score, incomplete resection of all EHD, EHD detected intraoperatively, and having received neoadjuvant chemotherapy to be independently associated with a worse survival. Patients with portal lymph node metastases had worse survival than those with lung or ovarian metastases. Among patients who had a complete resection of all disease, 95% recurred.Concurrent resection of hepatic and EHD in well-selected patients is associated with a possibility of long-term survival. The presence of limited and resectable EHD should not be an absolute contraindication to resection. The site of EHD and the nearly universal recurrence rate must be taken into consideration.