Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma
Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma
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DOI：
10.1097/00000658-200005000-00015
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发表时间：
2000-05-01
影响因子：
9
通讯作者：
Fuhrman, GM
中科院分区：
文献类型：
--
作者：
Bolton, JS;Fuhrman, GM
目的探讨结直肠癌多发双叶肝转移行肝切除术的远期疗效和治疗并发症。结果单纯肝转移组5年生存率为36%，复杂肝转移组5年生存率为37%。多因素分析显示，肿瘤累及的肝脏节段数和最大转移灶直径与5年生存率显著相关。手术死亡率单纯组为4.9%，复杂组为9.1%，差异无统计学意义。多因素分析显示，扩大肺叶切除和同时行结肠和肝切除是手术死亡的显著独立预测因素。结论根据本研究的定义，复杂肝转移瘤切除的5年生存率为37%，与局限性肝转移瘤切除的生存益处相同，如果需要扩大肝叶切除并同时行结直肠切除，这种侵袭性手术的死亡率显著高于单纯肝转移瘤切除组。在诊断为原发性结直肠癌时有复杂肝转移的患者，如果需要扩大肝叶切除，应在结肠切除后至少延迟3个月行肝切除。
ObjectiveTo define the long-term outcome and treatment complications for patients undergoing liver resection for multiple, bilobar hepatic metastases from colorectal cancer.MethodsA retrospective analysis of 165 consecutive patients undergoing liver resection for metastatic colorectal cancer was performed. Patients were divided into a simple hepatic metastasis group, consisting of patients with three or fewer metastases in a unilobar distribution, and a complex hepatic metastases group,consisting of patients with four or more unilobar metastases or at least two bilobar metastases.ResultsThe 5-year survival rate was 36% for the simple group and 37% for the complex group. Multivariate analysis revealed that the number of hepatic segments involved by tumor and the maximum diameter of the largest metastasis correlated significantly with the 5-year survival rate. The surgical death rate was 4.9% for the simple group and 9.1% for the complex group; this difference was not significant. Multivariate analysis revealed that extended lobar resection and concomitant colon and hepatic resection were significant and independent predictors of surgical death. The combination of extended lobar resection and concomitant colon resection was used significantly more frequently in the complex group than in the simple group.ConclusionsResection of complex hepatic metastases, as defined in this study, results in a 5-year survival rate of 37% and confers the same survival benefit as does resection of limited hepatic metastases, The surgical death rate for this aggressive approach is significantly higher if extended lobar resections are necessary and if concomitant colorectal resection is performed. Patients who have complex hepatic metastases at the time of diagnosis of the primary colorectal cancer and who would require extended hepatic lobectomy should have hepatic resection delayed for at least 3 months after colon resection.