Pessaux Patrick, Lermite Emilie, Brehant Olivier, Tuech Jean-Jacques, Lorimier Gérard, Arnaud Jean-Pierre
Department of Digestive Surgery, Chu Angers, Angers, France.
J Surg Oncol. 2006 Jan 1;93(1):1-7. doi: 10.1002/jso.20384.
Liver resection represents the best and potentially curative treatment for metastatic colorectal cancer (MCC) to the liver. After resection, however, most patients develop recurrent disease, often isolated to the liver. The aim of this study was to determine the value of repeat liver resection for recurrent MCC and to analyze the factors that can predict survival.
From January 1992 to October 2002, 42 patients from a group of 168 patients resected for MCC were submitted to 55 repeat hepatectomies (42 second, 11 third, and 2 fourth hepatectomies). Records were retrospectively reviewed. The primary tumor was carcinoma of the colon in 26 patients and carcinoma of the rectum in 16 patients. Liver metastases were synchronous in 24 patients (57.1%).
There were 25 men and 17 women with the mean age of 63.5 years (range: 34-80). There was no intraoperative or postoperative mortality. The morbidity rates were 9.5%, 14.3%, and 18.2% (P = 0.6) respectively after a first, second, or third hepatectomies. No patients needed reoperation. Operative duration was longer after a second or third hepatectomie than after a first hepatectomie without difference for operative bleeding. Overall 5-year survivals were 33%, 21%, and 36% respectively after a first, second, or third hepatectomies. Factors of prognostic value on univariate analysis included serum carcinoembryonic antigen levels (P = 0.01) during the first hepatectomy, the presence of extrahepatic disease (P = 0.05) and tumor size larger than 5 cm (P = 0.04) during the second hepatectomie.
Repeat hepatectomies can provide long-term survival rates similar to those of first hepatectomies.
肝切除是转移性结直肠癌（MCC）肝转移的最佳且可能治愈的治疗方法。然而，切除术后，大多数患者会出现复发性疾病，且常局限于肝脏。本研究的目的是确定复发性MCC再次肝切除的价值，并分析可预测生存的因素。
1992年1月至2002年10月，168例因MCC接受肝切除的患者中有42例接受了55次再次肝切除术（42例第二次、11例第三次和2例第四次肝切除术）。对记录进行回顾性分析。26例患者的原发肿瘤为结肠癌，16例为直肠癌。24例患者（57.1%）肝转移为同时性。
男性25例，女性17例，平均年龄63.5岁（范围：34 - 80岁）。无术中或术后死亡。首次、第二次或第三次肝切除术后的发病率分别为9.5%、14.3%和18.2%（P = 0.6）。无患者需要再次手术。第二次或第三次肝切除术后的手术时间比首次肝切除术后长，但手术出血量无差异。首次、第二次或第三次肝切除术后的总体5年生存率分别为33%、21%和36%。单因素分析中具有预后价值的因素包括首次肝切除时血清癌胚抗原水平（P = 0.01）、第二次肝切除时存在肝外疾病（P = 0.05）以及肿瘤大小大于5 cm（P = 0.04）。
再次肝切除可提供与首次肝切除相似的长期生存率。
