复发性结直肠癌肝转移的再次肝切除术
Repeat liver resection for recurrent colorectal liver metastases.
作者信息
Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Moriya Y, Sugihara K
机构信息
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
出版信息
Am J Surg. 1999 Oct;178(4):275-81. doi: 10.1016/s0002-9610(99)00176-2.
BACKGROUND
This study aimed to delineate the role of surgery for recurrent colorectal cancer in the liver and to identify prognosticators for better patient selection and outcome.
METHODS
Data from 90 repeat hepatectomies (second = 75; third = 12; fourth = 3) for recurrent colorectal cancer were collected.
RESULTS
After the second hepatectomy, the 3-and 5-year survival rates were 48% and 31%, respectively. Twenty-seven percent (20 of 75) of patients are alive without recurrence after a median follow-up of 27 months, and 9 survived more than 5 years. Four or more tumors, positive regional lymph node metastases, concomitant extrahepatic disease, and residual tumor were independent poor prognostic factors after the second hepatectomy.
CONCLUSIONS
Repeat hepatectomy should be applied for recurrent colorectal cancer, when curative removal of the tumor is possible, although the benefit from treatment was limited in a patient with regional lymph node metastases, 4 or more metastases, or extrahepatic disease.
背景
本研究旨在阐明手术在复发性结直肠癌肝转移中的作用，并确定预后因素，以便更好地选择患者并改善预后。
方法
收集了90例复发性结直肠癌再次肝切除术的数据（第二次肝切除术75例；第三次12例；第四次3例）。
结果
第二次肝切除术后，3年和5年生存率分别为48%和31%。75例患者中有27%（20例）在中位随访27个月后无复发存活，9例存活超过5年。第二次肝切除术后，肿瘤4个或更多、区域淋巴结转移阳性、合并肝外疾病和残留肿瘤是独立的不良预后因素。
结论
当肿瘤有可能根治性切除时，复发性结直肠癌应行再次肝切除术，尽管对于有区域淋巴结转移、4个或更多转移灶或肝外疾病的患者，治疗获益有限。
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