Stewart G D, O'Súilleabháin C B, Madhavan K K, Wigmore S J, Parks R W, Garden O J
Department of Clinical and Surgical Sciences (Surgery), Royal Infirmary of Edinburgh, University of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
Eur J Surg Oncol. 2004 May;30(4):370-6. doi: 10.1016/j.ejso.2004.01.011.
The acceptable indications for liver resection in patients with colorectal metastases have increased significantly in the last decade. It is thus becoming more difficult to ascertain the limitations for selection as the boundaries have been greatly extended. This has resulted in not only more extensive resections, but more atypical and bilobar resections. The aim of this study was to compare the outcome of patients undergoing different extent of liver resection in a specialist unit.
All patients undergoing liver resection for colorectal metastases at the Royal Infirmary of Edinburgh between October 1988 and April 2001 were reviewed. Patients were allocated into one of three groups: standard group, extended group, and segmental group. Patient information was collected from a prospectively completed database.
One hundred and thirty-seven patients had liver resections for colorectal metastases during the study period. There were 69 standard hepatectomies, 41 extended resections and 27 segmental resections. CEA level was significantly lower in the segmental group(p = 0.012). There was a significant difference between the groups in terms of median operating time (p < 0.0001, Kruskal-Wallis test), operative blood loss (p = 0.006, Kruskal-Wallis test) and post-operative stay ( p = 0.036, Kruskal-Wallis test). Major post-operative complications were similar between standard and extended resections but less following segmental resection (p = 0.050. Predicted median survival was 51 months following standard resection, 23 months following extended resection and 59 months after segmental resection ( p = 0.037, log rank test), however, there was no difference between the three groups for actual 5-year survival (p = 0.662, Pearson chi-square test).
Morbidity and mortality rates were comparable with other previous studies as was overall survival, although survival in patients undergoing extended resections was reduced. There was an acceptable level of morbidity and mortality for all three groups. Patients undergoing segmental resection had fewer complications, shorter length of stay, and the longest median survival suggesting adequate oncological clearance. Segmental resection has a role for favourably placed tumour deposits if oncological clearance can be ensured. Extended liver resections have a role for selected patients with bilobar colorectal metastases or large solitary deposits close to the hepatic vein confluence.
在过去十年中，结直肠癌肝转移患者肝切除的可接受指征显著增加。因此，随着界限大幅扩展，确定选择的局限性变得更加困难。这不仅导致了更广泛的切除，还出现了更多非典型和双侧叶切除。本研究的目的是比较在一个专科单位接受不同范围肝切除的患者的结局。
回顾了1988年10月至2001年4月在爱丁堡皇家医院接受结直肠癌肝转移肝切除的所有患者。患者被分为三组之一：标准组、扩大组和节段组。患者信息从前瞻性完成的数据库中收集。
在研究期间，137例患者因结直肠癌肝转移接受了肝切除。有69例标准肝切除术、41例扩大切除术和27例节段切除术。节段组的癌胚抗原（CEA）水平显著较低（p = 0.012）。三组在中位手术时间（p < 0.0001，Kruskal-Wallis检验）、术中失血（p = 0.006，Kruskal-Wallis检验）和术后住院时间（p = 0.036，Kruskal-Wallis检验）方面存在显著差异。标准切除和扩大切除后的主要术后并发症相似，但节段切除后较少（p = 0.050）。标准切除后预测的中位生存期为51个月，扩大切除后为23个月，节段切除后为59个月（p = 0.037，对数秩检验），然而，三组的实际5年生存率无差异（p = 0.662，Pearson卡方检验）。
发病率和死亡率与其他先前研究相当，总体生存率也是如此，尽管接受扩大切除的患者生存率降低。三组的发病率和死亡率都处于可接受水平。接受节段切除的患者并发症较少、住院时间较短，中位生存期最长，提示有足够的肿瘤学切缘。如果能确保肿瘤学切缘，节段切除对位置有利的肿瘤转移灶有作用。扩大肝切除对选定的双侧结直肠癌肝转移或靠近肝静脉汇合处的大孤立转移灶患者有作用。
