Lang H, Nussbaum K T, Weimann A, Raab R
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover.
Chirurg. 1999 Apr;70(4):439-46. doi: 10.1007/s001040050669.
Over a period of 11 years a total of 140 liver resections for non-colorectal, non-neuroendocrine hepatic metastases were performed in 127 patients (73 women, 54 men; median age 53 years). There were 120 first, 14 second and 6 third liver resections. Primary tumors were: breast cancer (n = 34), leiomyosarcoma (n = 20), pancreatic cancer (n = 16), renal cell carcinoma (n = 13), melanoma (n = 9), gastric cancer (n = 9), lung cancer (n = 6) and adrenal cancer (n = 6) and miscellaneous tumors (n = 14). Extrahepatic tumor manifestation (including synchronous primary tumors) was found in 69/140 cases (49%); 61 of 120 patients with a first liver resection had extrahepatic tumor (51%). In the 120 first liver resections, 82 (68%) R0, 13 (11%) R1 and 25 (21%) R2 excisions were possible. Median survival after first liver resection was 20 months; after R0 resection a median survival of 28 months and after R1/2 resection of 8 months was achieved. The 5-year survival rate was 16% for the total group, 24% in patients with R0 resection and 0% for R1/2 resections. After a second liver resection (n = 14) there was a median survival of 28 months (5-year-survival-rate of 21%) for all patients and of 41 months (5-year survival rate 38%) after R0 resection. Morbidity and mortality after the first liver resection were 32.5% and 5.8%, respectively. In patients without extrahepatic tumor at the time of the first liver resection a median survival of 32 months (5-year survival rate 25%) and 7 months was achieved after R0 resection and R1/2 resection, respectively. In case of extrahepatic tumor the median survival was 24 months (5-year survival rate 23%) for R0 resection compared to 8 months after R1/2 resection. These data suggest that not the presence of extrahepatic tumor but rather the possibility of a R0 resection is most decisive for the prognosis after liver resection. We conclude that patients with liver metastases of non-colorectal, non-neuroendocrine tumors may benefit from liver resection. Similar to colorectal metastases, a second or third liver resection can be worthwhile in selected cases. Even in more unfavorable tumor entities, several cases of long-term survival were observed after surgical therapy. Therefore, the indication for liver resection should be considered carefully in every single case.
在11年的时间里，共对127例患者（73例女性，54例男性；中位年龄53岁）进行了140例非结直肠癌、非神经内分泌性肝转移瘤的肝切除术。其中首次肝切除术120例，二次肝切除术14例，三次肝切除术6例。原发肿瘤包括：乳腺癌（n = 34）、平滑肌肉瘤（n = 20）、胰腺癌（n = 16）、肾细胞癌（n = 13）、黑色素瘤（n = 9）、胃癌（n = 9）、肺癌（n = 6）、肾上腺癌（n = 6）以及其他肿瘤（n = 14）。140例病例中有69例（49%）发现肝外肿瘤表现（包括同时性原发肿瘤）；120例首次肝切除术患者中有61例存在肝外肿瘤（51%）。在120例首次肝切除术中，82例（68%）实现了R0切除，13例（11%）为R1切除，25例（21%）为R2切除。首次肝切除术后的中位生存期为20个月；R0切除术后的中位生存期为28个月，R1/2切除术后为8个月。全组患者的5年生存率为16%，R0切除患者为24%，R1/2切除患者为0%。二次肝切除（n = 14）后，所有患者的中位生存期为28个月（5年生存率为21%），R0切除后为41个月（5年生存率为38%）。首次肝切除术后的并发症发生率和死亡率分别为32.5%和5.8%。首次肝切除时无肝外肿瘤的患者，R0切除和R1/2切除后的中位生存期分别为32个月（5年生存率为25%）和7个月。存在肝外肿瘤时，R0切除后的中位生存期为24个月（5年生存率为23%），R1/2切除后为8个月。这些数据表明，对肝切除术后预后起决定性作用的并非肝外肿瘤的存在，而是R0切除的可能性。我们得出结论，非结直肠癌、非神经内分泌肿瘤肝转移患者可能从肝切除术中获益。与结直肠癌转移类似，在某些特定病例中，二次或三次肝切除术可能是值得的。即使在更不利的肿瘤类型中，手术治疗后也观察到了几例长期生存病例。因此，对于每一个病例都应仔细考虑肝切除的适应证。
