Nagakura Shigenori, Shirai Yoshio, Wakai Toshifumi, Nomura Tatsuya, Hatakeyama Katsuyoshi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510 Japan.
Hepatogastroenterology. 2003 Jul-Aug;50(52):1032-3.
Hepatectomy is an established treatment for colorectal carcinoma liver metastases. However, the benefit of multiple repeat metastasectomies in the management of colorectal carcinoma patients remains uncertain. We report the case of a 47-year-old man who underwent ten sequential resections of intra- and extrahepatic colonic adenocarcinoma metastases. Metastasectomy procedures in this case included: 6 hepatic resections, 2 pulmonary resections, 1 pulmonary resection combined with wide resection of the abdominal wall, and 1 wide resection of the abdominal wall. The patient finally died, from unresectable metastases to the liver and pancreas, 133 months after the initial hepatectomy. The aggressive multiple repeat metastasectomies may have provided this unusual long-term palliation. Colorectal carcinoma patients with sequential resectable recurrences may be candidates for multiple repeat metastasectomies. Surgeons should pursue resection for colorectal carcinoma metastases, regardless of frequent operations and sites involved, as reliable medical treatment remains unestablished.
肝切除术是治疗结直肠癌肝转移的一种既定方法。然而，多次重复肝转移瘤切除术在结直肠癌患者管理中的益处仍不明确。我们报告了一例47岁男性患者，他先后接受了10次肝内和肝外结肠腺癌转移灶切除术。该病例的肝转移瘤切除手术包括：6次肝脏切除术、2次肺部切除术、1次肺部切除术联合腹壁广泛切除术以及1次腹壁广泛切除术。患者最终在初次肝切除术后133个月死于无法切除的肝脏和胰腺转移瘤。积极的多次重复肝转移瘤切除术可能为患者提供了这种不同寻常的长期姑息治疗。结直肠癌患者若出现可依次切除的复发病灶，可能适合多次重复肝转移瘤切除术。外科医生应积极切除结直肠癌转移灶，无论手术频率和涉及部位如何，因为可靠的药物治疗尚未确立。
