Weber S M, Jarnagin W R, DeMatteo R P, Blumgart L H, Fong Y
Hepatobiliary Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Surg Oncol. 2000 Oct;7(9):643-50. doi: 10.1007/s10434-000-0643-3.
Hepatic resection is potentially curative in selected patients with colorectal metastases. It is a widely held practice that multiple colorectal hepatic metastases are not resected, although outcome after removal of four or more metastases is not well defined.
Patients with four or more colorectal hepatic metastases who submitted to resection were identified from a prospective database. Number of metastases was determined by serial sectioning of the gross specimen at the time of resection. Demographic data, tumor characteristics, complications, and survival were analyzed.
From August 1985 to September 1998, 155 patients with four or more metastatic tumors (range 4-20) underwent potentially curative resection by extended hepatectomy (39%), lobectomy (42%), or multiple segmental resections (19%). Operative morbidity and mortality were 26% and 1%, respectively. Actuarial 5-year survival was 23% for the entire group (median = 32 months) and there were 12 actual 5-year survivors. On multivariate analysis, only number of hepatic tumors (P = .005) and the presence of a positive margin (P = .003) were independent predictors of poor survival.
Hepatic resection in patients with four or more colorectal metastases can achieve long-term survival although the results are less favorable as the number of tumors increases. Number of hepatic metastases alone should not be used as a sole contraindication to resection, but it is clear that the majority of patients will not be cured after resection of multiple lesions.
肝切除术对部分结直肠癌肝转移患者可能具有治愈效果。尽管对于切除四个或更多转移灶后的结果尚无明确界定，但普遍认为不应对多个结直肠癌肝转移灶进行切除。
从一个前瞻性数据库中识别出接受了切除手术的有四个或更多结直肠癌肝转移灶的患者。转移灶数量通过切除时大体标本的连续切片来确定。对人口统计学数据、肿瘤特征、并发症和生存率进行分析。
1985年8月至1998年9月，155例有四个或更多转移瘤（范围为4 - 20个）的患者接受了扩大肝切除术（39%）、肝叶切除术（42%）或多段切除术（19%），进行了可能治愈性的切除。手术 morbidity和死亡率分别为26%和1%。整个组的精算5年生存率为23%（中位数 = 32个月），有12例实际存活5年的患者。多因素分析显示，只有肝肿瘤数量（P = .005）和切缘阳性（P = .003）是生存不良的独立预测因素。
有四个或更多结直肠癌转移灶的患者进行肝切除可实现长期生存，尽管随着肿瘤数量增加结果不太理想。不应仅将肝转移灶数量作为切除的唯一禁忌证，但显然大多数患者在切除多个病灶后无法治愈。
