Fukunaga Kiyoshi, Takada Yasutsugu, Otsuka Masaaki, Todoroki Takeshi, Fukao Katashi
Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan.
Hepatogastroenterology. 2003 Nov-Dec;50(54):1894-7.
BACKGROUND/AIMS: Hepatectomy is generally considered the only mode of curative treatment available for patients with colorectal liver metastases, even though recurrence occurs in more than 60% of the patients.
This is a retrospective study examining the survival of 11 patients undergoing surgical excision of recurrences gained from 46 patients undergoing initial hepatectomy for metastatic colorectal cancer. These 46 patients had curative hepatectomy and no extrahepatic metastasis.
Cancer recurred in 29 of the 46 patients after a median follow-up time of 29.5 months (range 2-183 months), and 11 had curative resection of localized recurrences. In 6 patients, the liver was the only site of recurrence and 4 patients had isolated lung metastases. One patient had liver and lung metastases. There was no perioperative mortality. The median survival time and cumulative 5-year survival rate for 11 patients after the repeated resection were 28 months and 43.8%, respectively. These results were comparable to the survival for 46 patients after the initial hepatectomy, in which the median survival was 29.5 months and the 5-year survival rate was 49.0%.
In appropriately selected patients with colorectal cancer, surgical excision of localized recurrences after hepatectomy may be effective in prolonging survival.
背景/目的：肝切除术通常被认为是结直肠癌肝转移患者唯一可行的治愈性治疗方式，即便超过60%的患者会复发。
这是一项回顾性研究，对46例行初次肝切除术治疗转移性结直肠癌的患者中11例复发病灶手术切除后的生存情况进行分析。这46例患者均接受了根治性肝切除术且无肝外转移。
46例患者中位随访时间29.5个月（范围2 - 183个月）后，29例出现癌症复发，其中11例接受了局限性复发病灶的根治性切除。6例患者仅肝脏复发，4例有孤立性肺转移。1例患者肝脏和肺均有转移。围手术期无死亡病例。11例患者再次切除术后的中位生存时间和5年累积生存率分别为28个月和43.8%。这些结果与46例患者初次肝切除术后的生存情况相当，初次肝切除术后中位生存时间为29.5个月，5年生存率为49.0%。
对于经过适当选择的结直肠癌患者，肝切除术后对局限性复发病灶进行手术切除可能有效延长生存期。
