Yamamoto J, Shimada K, Kosuge T, Yamasaki S, Sakamoto M, Fukuda H
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
Br J Surg. 1999 Mar;86(3):332-7. doi: 10.1046/j.1365-2168.1999.01030.x.
The extent of surgical margin is still a matter of controversy with regard to outcome after liver resection for metastatic disease. The aim of this study was to clarify the significant prognostic factors after hepatectomy for colorectal metastases, with special reference to the surgical margin.
Ninety-six patients who underwent initial hepatic resection for liver metastases from colorectal cancer between 1992 and 1994 were studied.
Overall 1-, 3- and 5-year survival rates were 94, 61 and 51 per cent respectively. All of the independent factors associated with poor prognosis after hepatic resection were tumour-related factors, such as the number of tumours (four or more), presence of portal vein invasion, hepatic vein invasion and absence of a fibrous pseudocapsule. A positive resection margin was not an independent prognostic factor, because of its strong relationship with the number of tumours resected.
A generous surgical margin is not essential for curative hepatic resection, although positive surgical margins should be avoided. New potential risk factors which affect survival, such as the presence of portal vein or hepatic vein invasion and the absence of a pseudocapsule, may be helpful for defining the indications for postoperative adjuvant treatment.
对于转移性疾病肝切除术后的预后，手术切缘的范围仍是一个存在争议的问题。本研究的目的是阐明结直肠癌肝转移肝切除术后的重要预后因素，特别关注手术切缘。
对1992年至1994年间因结直肠癌肝转移而接受初次肝切除的96例患者进行了研究。
总体1年、3年和5年生存率分别为94%、61%和51%。肝切除术后与预后不良相关的所有独立因素均为肿瘤相关因素，如肿瘤数量（四个或更多）、门静脉侵犯、肝静脉侵犯以及无纤维假包膜。切缘阳性不是一个独立的预后因素，因为它与切除的肿瘤数量密切相关。
尽管应避免切缘阳性，但对于根治性肝切除而言，宽大的手术切缘并非必不可少。影响生存的新的潜在危险因素，如门静脉或肝静脉侵犯的存在以及假包膜的缺失，可能有助于确定术后辅助治疗的适应证。
