Jovine E, Biolchini F, Talarico F, Lerro F M, Mastrangelo L, Selleri S, Landolfo G, Martuzzi F, Iusco D R, Lazzari A
Surgical Department, Maggiore Hospital, Bologna, Italy.
Colorectal Dis. 2007 Mar;9(3):245-52. doi: 10.1111/j.1463-1318.2006.01152.x.
Synchronous hepatic lesions account for 15-25% of newly diagnosed colorectal cancer and its optimal timing to surgery is not completely defined, but simultaneous colorectal and liver resection is recently gaining acceptance, at least in patients with a right colonic primary and liver metastases that need a minor hepatectomy to be fully resected.
From September 2002 to December 2004, 16 patients underwent simultaneous resection as treatment of synchronous colorectal liver resection; in 10 patients (62.5%) a major hepatectomy was performed.
The mean duration of intervention was 322.5 +/- 59.5 min, operative mortality and morbidity rates was 0% and 25% respectively; the hospitalization was 14.4 (range 8-60) days on average. Mean follow-up was 14 months and actuarial survival was 76.5% at 1 year and 63.5% at 2 years.
We concluded that simultaneous colonic and liver resection should be undertaken in selected patients with synchronous colorectal liver resection regardless of the extent of hepatectomy; major liver resection, in fact, seems capable of providing better oncological results, allowing resection of liver micrometastases that, in almost one-third of the patients, are located in the same liver lobe of macroscopic lesions, without increased morbidity rates.
同时性肝转移瘤占新诊断结直肠癌的15% - 25%，其最佳手术时机尚未完全明确，但结直肠癌与肝脏同时切除近来逐渐被接受，至少对于右半结肠癌原发灶合并肝转移且需行小范围肝切除以实现根治性切除的患者是如此。
2002年9月至2004年12月，16例患者接受了同时性切除作为同时性结直肠癌肝转移瘤的治疗；其中10例患者（62.5%）接受了大范围肝切除。
平均手术时间为322.5 ± 59.5分钟，手术死亡率和发病率分别为0%和25%；平均住院时间为14.4天（范围8 - 60天）。平均随访14个月，1年和2年的精算生存率分别为76.5%和63.5%。
我们得出结论，对于选择的同时性结直肠癌肝转移患者，无论肝切除范围如何，均应进行结直肠癌与肝脏同时切除；事实上，大范围肝切除似乎能够提供更好的肿瘤学效果，可切除肝微转移灶，近三分之一患者的肝微转移灶位于与肉眼可见病灶相同的肝叶，且发病率并未增加。
