[非结直肠癌和非神经内分泌性肝转移瘤的手术治疗]

Zacherl M, Längle F, Steininger R, Scheuba C, Wenzl E, Jakesz R, Zacherl J

Klinische Abteilung für Allgemeinchirurgie, Klinische Abteilung für Transplantation, Universitätsklinik für Chirurgie, Universität Wien, Osterreich.

Wien Klin Wochenschr. 2001 Sep 17;113(17-18):681-7.

INTRODUCTION

Hepatic resection has been shown to prolong survival in selected patients with colorectal liver metastases. Due to slow tumor growth patients with neuroendocrine liver metastases tend to have a good prognosis and benefit from chemo-embolisation and symptomatic treatment. The role of surgery in treating non-neuroendocrine and non-colorectal liver metastases is discussed controversially, due to the limited knowledge on this subject. The aim of our study was, therefore, to evaluate our own experiences with hepatic surgery for non-neuroendocrine, non-colorectal liver metastases.

METHODS

A retrospective review of 72 patients (median age 60.9 years) who underwent 73 hepatic resections for non-neuroendocrine, non-colorectal liver metastases between 1980 and 2000 at a single tertial referral center was carried out.

RESULTS

Hepatic resection was combined with surgery for the primary tumor in 30 cases (41.1%). Hospital mortality was 4.2%. 35 patients (47.9%) developed complications. The mean hospital stay was 17.5 days. In 64.4% of the cases a potentially curative resection was reached. Overall actuarial survival was 52.1% at 1 year, 25.3% at 3 years and 9.9% at 5 years. The respective median overall survival times were 7.1 months (gastric cancer metastases; n = 15), 4.9 months (cholangiocellular cancer metastases; n = 9), 5.6 months (gall bladder, bile duct cancer metastases; n = 8), 35.4 months (kidney cancer metastases; n = 8), 14.4 months (breast cancer metastases; n = 4), 15.3 months (pancreas and other adenocarcinoma metastases; n = 11), 49.9 months (sarcoma metastases; n = 10) and 32.9 months (other metastases; n = 7).

CONCLUSIONS

In isolated hepatic metastases originating from sarcoma and hypernephroma radical resection can prolong survival. However, surgery cannot improve the prognosis in patients with liver metastases originating from the pancreas, gallbladder and the biliary tract. In selected patients with liver metastases from gastric and breast cancer long term survival seems possible after resection.

引言

肝切除术已被证明可延长部分结直肠癌肝转移患者的生存期。由于神经内分泌肝转移瘤生长缓慢，此类患者往往预后良好，并能从化疗栓塞和对症治疗中获益。由于对此类疾病的了解有限，手术在治疗非神经内分泌和非结直肠癌肝转移中的作用存在争议。因此，我们研究的目的是评估我们自身对于非神经内分泌、非结直肠癌肝转移患者进行肝手术的经验。

方法

对1980年至2000年间在一家三级转诊中心接受73例非神经内分泌、非结直肠癌肝转移肝切除术的72例患者（中位年龄60.9岁）进行回顾性研究。

结果

30例（41.1%）肝切除术联合了原发肿瘤手术。医院死亡率为4.2%。35例患者（47.9%）出现并发症。平均住院时间为17.5天。64.4%的病例实现了潜在根治性切除。1年、3年和5年的总体精算生存率分别为52.1%、25.3%和9.9%。各自的中位总生存时间分别为7.1个月（胃癌转移；n = 15）、4.9个月（胆管细胞癌转移；n = 9）、5.6个月（胆囊、胆管癌转移；n = 8）、35.4个月（肾癌转移；n = 8）、14.4个月（乳腺癌转移；n = 4）、15.3个月（胰腺及其他腺癌转移；n = 11）、49.9个月（肉瘤转移；n = 10）和32.9个月（其他转移；n = 7）。