Yan T D, Lian K Q, Chang D, Morris D L
Department of Surgery, University of New South Wales, St George Hospital, Sydney, New South Wales, Australia.
Br J Surg. 2006 Jul;93(7):854-9. doi: 10.1002/bjs.5359.
Management of intrahepatic recurrence after complete surgical treatment for colorectal liver metastases is not well defined. The aim of this study was to analyse the survival results of patients who had repeat liver resection for intrahepatic recurrence and to evaluate prognostic indicators for survival.
Between 1991 and 2005, 55 patients had repeat liver resection for isolated intrahepatic recurrence. The long-term survival results were assessed. Univariable and multivariable analyses were used to identify prognostic indicators for survival after repeat hepatectomy.
The median survival was 53 (range 2-97) months and the 5-year survival rate was 49 per cent. In univariable analysis, size of largest initial liver metastasis, margin of initial liver surgery, carcinoembryonic antigen (CEA) level before and after initial liver surgery, liver disease-free survival, margin of repeat liver surgery, operation type of repeat surgery and CEA level before and after repeat surgery were significant prognostic factors. In multivariable analysis, largest initial liver metastasis 4 cm or less and CEA level 5 ng/ml or less after repeat liver surgery were independently associated with improved survival.
Repeat hepatectomy can achieve an acceptable survival in selected patients with isolated intrahepatic recurrence.
结直肠癌肝转移完全手术治疗后肝内复发的管理尚无明确界定。本研究的目的是分析因肝内复发接受再次肝切除患者的生存结果，并评估生存的预后指标。
1991年至2005年间，55例患者因孤立性肝内复发接受了再次肝切除。评估长期生存结果。采用单变量和多变量分析确定再次肝切除术后生存的预后指标。
中位生存期为53（范围2 - 97）个月，5年生存率为49%。在单变量分析中，最大初始肝转移灶大小、初始肝手术切缘、初始肝手术前后癌胚抗原（CEA）水平、无肝病生存期、再次肝手术切缘、再次手术的术式以及再次手术前后CEA水平是显著的预后因素。在多变量分析中，最大初始肝转移灶4 cm或更小以及再次肝切除术后CEA水平5 ng/ml或更低与生存改善独立相关。
对于部分孤立性肝内复发患者，再次肝切除可获得可接受的生存结果。
