Sa Cunha Antonio, Laurent Christophe, Rault Alexandre, Couderc Philippe, Rullier Eric, Saric Jean
Department of Digestive Surgery, University Hospital of Bordeaux, Ave de Magellan, Pessac 33604, Bordeaux, France.
Arch Surg. 2007 Dec;142(12):1144-9; discussion 1150. doi: 10.1001/archsurg.142.12.1144.
Repeat liver resection because of recurrent colorectal liver metastases can provide survival benefit with a low rate of complications.
Retrospective study.
Forty patients who underwent a second hepatectomy because of liver metastases from colorectal cancer.
Short- and long-term results of a second hepatectomy and determination of prognostic factors.
The postoperative mortality rate was 2.5%. The postoperative morbidity rate was not significantly different after a second hepatectomy compared with single hepatectomy (42.5% and 27.5%, respectively; P = .10). Transfusion requirement and hospital stay were comparable for both a single and a second hepatectomy. Three- and 5-year overall survival rates were 55% and 31%, respectively. Disease-free survival rates at 3 and 5 years were, respectively, 49% and 27%. The interval between first and second hepatectomies and the presence of extrahepatic disease were independently related to survival (multivariate analysis).
A second liver resection because of recurrent liver metastases from colorectal cancer is safe and provides a survival benefit similar to that with single hepatectomy. Our analysis suggests that the benefit of treatment is limited in patients who undergo a second hepatectomy within 1 year of the first operation and in those with extrahepatic disease.
因结直肠癌肝转移复发而进行的再次肝切除可带来生存获益，且并发症发生率较低。
回顾性研究。
40例因结直肠癌肝转移接受二次肝切除的患者。
二次肝切除的短期和长期结果以及预后因素的确定。
术后死亡率为2.5%。二次肝切除术后的发病率与单次肝切除术后相比无显著差异（分别为42.5%和27.5%；P = 0.10）。单次肝切除和二次肝切除的输血需求和住院时间相当。3年和5年总生存率分别为55%和31%。3年和5年无病生存率分别为49%和27%。首次和二次肝切除之间的间隔时间以及肝外疾病的存在与生存独立相关（多变量分析）。
因结直肠癌肝转移复发而进行的二次肝切除是安全的，且能带来与单次肝切除相似的生存获益。我们的分析表明，在首次手术1年内接受二次肝切除的患者以及患有肝外疾病的患者中，治疗获益有限。
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