Vassiliou Ioannis, Arkadopoulos Nick, Theodosopoulos Theodosios, Fragulidis Georgios, Marinis Athanasios, Kondi-Paphiti Agathi, Samanides Lazaros, Polydorou Andreas, Gennatas Constantinos, Voros Dionysios, Smyrniotis Vassilios
2nd Department of Surgery, Aretaieion Hospital, University of Athens, School of Medicine, FACS, 29 El. Venizelou str., GR-154 51 Athens, Greece.
World J Gastroenterol. 2007 Mar 7;13(9):1431-4. doi: 10.3748/wjg.v13.i9.1431.
To compare the safety and efficacy of simultaneous versus two stage resection of primary colorectal tumors and liver metastases.
From January 1996 to May 2004, 103 colorectal tumor patients presented with synchronous liver metastases. Twenty five underwent simultaneous colorectal and liver surgery and 78 underwent liver surgery 1-3 mo after primary colorectal tumor resection. Data were retrospectively analyzed to assess and compare the morbidity and mortality between the surgical strategies. The two groups were comparable regarding the age and sex distribution, the types of liver resection and stage of primary tumors, as well as the number and size of liver metastases.
In two-stage procedures more transfusions were required (4 +/- 1.5 vs 2 +/- 1.8, pRBCs, P < 0.05). Chest infection was increased after the two-stage approach (26% vs 17%, P < 0.05). The two-stage procedure was also associated with longer hospitalization (20 +/- 8 vs 12 +/- 6 d, P < 0.05). Five year survival in both groups was similar (28% vs 31%). No hospital mortality occurred in our series.
Synchronous colorectal liver metastases can be safely treated simultaneously with the primary tumor. Liver resection should be prioritized over colon resection. It is advisable that complex liver resections with marginal liver residual volume should be dealt with at a later stage.
比较原发性结直肠癌肿瘤与肝转移瘤同期切除和分期切除的安全性及疗效。
1996年1月至2004年5月，103例结直肠癌患者出现同时性肝转移。25例行结直肠癌与肝脏同期手术，78例行原发性结直肠癌肿瘤切除术后1 - 3个月行肝脏手术。对数据进行回顾性分析，以评估和比较两种手术策略的发病率和死亡率。两组在年龄和性别分布、肝切除类型、原发性肿瘤分期以及肝转移瘤的数量和大小方面具有可比性。
分期手术需要更多输血（4±1.5对2±1.8，pRBCs，P<0.05）。分期手术术后肺部感染增加（26%对17%，P<0.05）。分期手术还与更长的住院时间相关（20±8对12±6天，P<0.05）。两组的5年生存率相似（28%对31%）。本系列中无医院死亡病例。
同时性结直肠癌肝转移可与原发性肿瘤同期安全治疗。肝切除应优先于结肠切除。对于肝剩余体积边缘的复杂肝切除，建议在后期进行处理。
