Oshowo A, Gillams A, Harrison E, Lees W R, Taylor I
Department of Surgery, Royal Free and University College Medical School, University College London, London, UK.
Br J Surg. 2003 Oct;90(10):1240-3. doi: 10.1002/bjs.4264.
Liver resection is the treatment of choice for patients with solitary colorectal liver metastases. In recent years, however, radiofrequency ablation has been used increasingly in the treatment of colorectal liver metastases. In the absence of randomized clinical trials, this study aimed to compare outcome in patients with solitary colorectal liver metastases treated by surgery or by radiofrequency ablation.
Solitary colorectal liver metastases were treated by radiofrequency destruction in 25 patients. The indications were extrahepatic disease in seven, vessel contiguity in nine and co-morbidity in nine patients. Outcome was compared with that of 20 patients who were treated by liver resection for solitary metastases and had no evidence of extrahepatic disease. Most patients in both groups also received systemic chemotherapy.
Median survival after liver resection was 41 (range 0-97) months with a 3-year survival rate of 55.4 per cent. There was one postoperative death and morbidity was minimal. Median survival after radiofrequency ablation was 37 (range 9-67) months with a 3-year survival rate of 52.6 per cent.
Survival after resection and radiofrequency ablation of solitary colorectal liver metastases was comparable. The latter is less invasive and requires either an overnight stay or day-case facilities only.
肝切除术是孤立性结直肠癌肝转移患者的首选治疗方法。然而近年来，射频消融在结直肠癌肝转移的治疗中应用越来越广泛。由于缺乏随机临床试验，本研究旨在比较接受手术或射频消融治疗的孤立性结直肠癌肝转移患者的治疗结果。
25例患者采用射频毁损治疗孤立性结直肠癌肝转移。其中7例有肝外疾病，9例有血管毗邻，9例有合并症。将结果与20例因孤立性转移接受肝切除术且无肝外疾病证据的患者进行比较。两组大多数患者也接受了全身化疗。
肝切除术后的中位生存期为41个月（范围0 - 97个月），3年生存率为55.4%。术后有1例死亡，并发症极少。射频消融术后的中位生存期为37个月（范围9 - 67个月），3年生存率为52.6%。
孤立性结直肠癌肝转移切除术后和射频消融术后的生存率相当。后者创伤较小，仅需过夜住院或日间手术设施即可。
