Weber J C, Bachellier P, Oussoultzoglou E, Jaeck D
Service de Chirurgie Générale, Hépatique et Endocrinienne, Hôpital de Hautepierre, Strasbourg, France.
Br J Surg. 2003 Aug;90(8):956-62. doi: 10.1002/bjs.4132.
The surgical strategy for treatment of synchronous colorectal liver metastases remains controversial. The outcome and overall survival of patients presenting with such metastases, treated either by simultaneous resection or by delayed resection, were evaluated.
From 1987 to 2000, 97 patients presented with synchronous colorectal liver metastases, of whom 35 (36 per cent) underwent a simultaneous resection and 62 patients (64 per cent) a delayed resection. Simultaneous resection was considered prospectively for patients with fewer than four unilobar metastases.
Age, blood transfusion requirements, operating time, duration of inflow occlusion, hospital stay and mortality rate were similar in the two groups. The morbidity rate did not differ significantly (23 per cent after simultaneous resection and 32 per cent after delayed resection). The location of the primary tumour and extent of liver resection did not influence the morbidity rate significantly in the simultaneous resection group. The overall survival rate was 94, 45 and 21 per cent at 1, 3 and 5 years respectively after simultaneous resection, and 92, 45 and 22 per cent after delayed resection.
In selected patients, simultaneous resection of the colorectal primary tumour and liver metastases does not increase mortality or morbidity rates compared with delayed resection, even if a left colectomy and/or a major hepatectomy are required.
同步性结直肠癌肝转移的手术治疗策略仍存在争议。对出现此类转移的患者采用同期切除或延期切除治疗后的结果及总生存率进行了评估。
1987年至2000年，97例患者出现同步性结直肠癌肝转移，其中35例（36%）接受了同期切除，62例（64%）接受了延期切除。对于单叶转移灶少于4个的患者前瞻性地考虑同期切除。
两组患者的年龄、输血需求、手术时间、入肝血流阻断时间、住院时间及死亡率相似。发病率无显著差异（同期切除后为23%，延期切除后为32%）。在同期切除组中，原发肿瘤的位置及肝切除范围对发病率无显著影响。同期切除后1年、3年和5年的总生存率分别为94%、45%和21%，延期切除后分别为92%、45%和22%。
在选定的患者中，结直肠癌原发肿瘤与肝转移灶同期切除与延期切除相比，即使需要行左半结肠切除术和/或肝大部切除术，也不会增加死亡率或发病率。
