Martin Robert, Paty Philip, Fong Yuman, Grace Andrew, Cohen Alfred, DeMatteo Ronald, Jarnagin William, Blumgart Leslie
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Am Coll Surg. 2003 Aug;197(2):233-41; discussion 241-2. doi: 10.1016/S1072-7515(03)00390-9.
The optimal surgical strategy for the treatment of synchronous resectable colorectal liver metastasis has not been defined. The aims of this study were to review our experience with synchronous colorectal metastasis and to define the safety of simultaneous versus staged resection of the colon and liver.
From September 1984 through November 2001, 240 patients were treated surgically for primary adenocarcinoma of the large bowel and synchronous hepatic metastasis. Clinicopathologic, operative, and perioperative data were reviewed to evaluate selection criteria, operative methods, and perioperative outcomes.
One hundred thirty-four patients underwent simultaneous resection of a colorectal primary and hepatic metastasis in a single operation (Group I), and 106 patients underwent staged operations (Group II). Simultaneous resections tend to be performed for right colon primaries (p < 0.001), smaller (p < 0.01) and fewer (p < 0.001) liver metastases, and less extensive liver resection (p < 0.001). Complications were less common in the simultaneous resection group, with 65 patients (49%) sustaining 142 complications, compared with 71 patients (67%) sustaining 197 complications for both hospitalizations in the staged resection group (p < 0.003). Patients having simultaneous resection required fewer days in the hospital (median 10 days versus 18 days, p = 0.001). Perioperative mortality was similar (simultaneous, n = 3; staged, n = 3).
Simultaneous colon and liver resection is safe and efficient in the treatment of patients with colorectal cancer and synchronous liver metastasis. By avoiding a second laparotomy, the overall complication rate is reduced, with no change in operative mortality. Given its reduced morbidity, shorter treatment time, and similar cancer outcomes, simultaneous resection should be considered a safe option in patients with resectable synchronous colorectal metastasis.
同步可切除结直肠癌肝转移的最佳手术策略尚未明确。本研究的目的是回顾我们治疗同步结直肠癌转移的经验，并确定同期与分期切除结肠和肝脏的安全性。
从1984年9月至2001年11月，240例患者接受了大肠原发性腺癌合并同步肝转移的手术治疗。回顾临床病理、手术及围手术期数据，以评估选择标准、手术方法和围手术期结果。
134例患者在一次手术中同期切除结直肠癌原发灶和肝转移灶（I组），106例患者接受分期手术（II组）。同期切除倾向于用于右半结肠原发灶（p<0.001）、较小（p<0.01）且数量较少（p<0.001）的肝转移灶，以及肝切除范围较小的情况（p<0.001）。同期切除组并发症较少见，65例患者（49%）出现142例并发症，而分期切除组两次住院期间分别有71例患者（67%）出现197例并发症（p<0.003）。同期切除的患者住院天数较少（中位数10天对18天，p=0.001）。围手术期死亡率相似（同期，n=3；分期，n=3）。
同期结肠和肝脏切除治疗结直肠癌合并同步肝转移患者安全有效。通过避免二次剖腹手术，总体并发症发生率降低，手术死亡率无变化。鉴于其发病率降低、治疗时间缩短且癌症结局相似，同期切除应被视为可切除同步结直肠癌转移患者的安全选择。
