Ji Z-L, Peng S-Y, Yuan A-J, Li P-J, Zhang W, Yu Y
Department of General Surgery, Nantong Rich Hospital, The 4th Clinical Medical College, Yangzhou University, Nantong, Jiangsu 226010, PR China.
Tech Coloproctol. 2004 Nov;8 Suppl 1:s47-9. doi: 10.1007/s10151-004-0109-x.
Liver metastases from colorectal cancer are treatable and potentially curable when hepatic resection is applied. This paper is to illustrate surgical treatment of metastatic colorectal cancer in China.
Between January 1993 and December 2002, 485 patients with colorectal liver metastases from 6 institutes in China were reviewed. Among them were 340 males and 145 females with average ages of 55.6 years (23-81). Surgical intervention includes primary colorectal cancer resection, hepatic resection, hepatic arterial chemoembolisation and portal vein catheterisation, and systemic chemotherapy.
Among 485 cases, data were not complete in 76, and their 3-year survival rate was 35.7%, while from 409 patients who underwent surgical intervention, 11 cases only underwent colorectal cancer resection (group A); 89 with hepatic resection (group B); 204 with hepatic arterial intervention or portal vein catheterisation chemotherapy (group C); 21 with regional ablation by radiofrequency or microwave thermal coagulation (group D); and 84 with systemic chemotherapy (group E). The cumulative 3- and 5-year survival rates were 0% in groups A and E, 43.5% and 32.1% in group B, 27.1% and 0% in group C, and 42.9% and 19.2% in group D.
Surgery can offer long-term survival and resection should be considered when liver metastases can be totally resected with clear margins and when there is no nonresectable extrahepatic disease. The choice between anatomical or wedge resection depends on the number and the location of the metastases. Special multifunctional operative device limit blood loss and increase resectability.
结直肠癌肝转移灶在采用肝切除术后是可治疗且有可能治愈的。本文旨在阐述中国转移性结直肠癌的外科治疗情况。
回顾了1993年1月至2002年12月期间来自中国6家机构的485例结直肠癌肝转移患者。其中男性340例，女性145例，平均年龄55.6岁（23 - 81岁）。手术干预包括原发性结直肠癌切除、肝切除、肝动脉化疗栓塞及门静脉置管，以及全身化疗。
485例中，76例数据不完整，其3年生存率为35.7%，而在409例接受手术干预的患者中，11例仅接受了结直肠癌切除（A组）；89例接受了肝切除（B组）；204例接受了肝动脉介入或门静脉置管化疗（C组）；21例接受了射频或微波热凝区域消融（D组）；84例接受了全身化疗（E组）。A组和E组的3年及5年累积生存率均为0%，B组分别为43.5%和32.1%，C组分别为27.1%和0%，D组分别为42.9%和19.2%。
手术可提供长期生存，当肝转移灶能在切缘阴性的情况下完全切除且不存在不可切除的肝外疾病时，应考虑进行切除。解剖性切除或楔形切除的选择取决于转移灶的数量和位置。特殊的多功能手术器械可减少失血并提高可切除性。
