van Ooijen B, Wiggers T, Meijer S, van der Heijde M N, Slooff M J, van de Velde C J, Obertop H, Gouma D J, Bruggink E D, Lange J F
Department of Surgical Oncology and Statistics, Dr. Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
Cancer. 1992 Jul 1;70(1):28-34. doi: 10.1002/1097-0142(19920701)70:1<28::aid-cncr2820700105>3.0.co;2-9.
The records of 118 patients who had hepatic resections for colorectal liver metastases were analyzed retrospectively.
The patient group, from 15 institutions in The Netherlands, was found to have a 5-year actuarial survival rate of 21% and a 5-year actuarial disease-free survival rate of 19%. The postoperative mortality rate was 7.6%. In the remaining group, the morbidity rate was 34.7%. A number of factors were examined that were reported to be of prospective significance in other studies. In the multivariate proportional hazard model of Cox, the number of metastases (P = 0.001) and the amount of perioperative blood loss (P = 0.002) were related significantly to disease-free survival. A factor that may be considered a contraindication to resection is the presence of extrahepatic disease (whether nodal or visceral), even if resectable.
Although the actual benefit of resection is limited, and it is associated with considerable morbidity, surgical therapy offers some patients a chance for cure. It is a valid expectation that improvement in techniques and a proper understanding of hepatic anatomy will improve the safety and efficacy of hepatic resections in the future. Future research should focus on defining better selection criteria and on study of the value of adjuvant treatment modalities.
回顾性分析118例行肝切除治疗结直肠癌肝转移患者的病历资料。
来自荷兰15家机构的患者组5年精算生存率为21%，5年精算无病生存率为19%。术后死亡率为7.6%。其余患者组的发病率为34.7%。研究了其他研究中报道具有前瞻性意义的一些因素。在Cox多变量比例风险模型中，转移灶数量（P = 0.001）和围手术期失血量（P = 0.002）与无病生存显著相关。即使可切除，肝外疾病（无论是淋巴结转移还是内脏转移）的存在可能被视为手术切除的禁忌证。
尽管手术切除的实际获益有限，且伴有相当高的发病率，但手术治疗为部分患者提供了治愈机会。合理期望未来技术的改进以及对肝脏解剖结构的正确理解将提高肝切除的安全性和有效性。未来研究应聚焦于确定更好的选择标准以及辅助治疗方式价值的研究。
