Wakai Toshifumi, Shirai Yoshio, Sakata Jun, Valera Vladimir A, Korita Pavel V, Akazawa Kouhei, Ajioka Yoichi, Hatakeyama Katsuyoshi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan.
Ann Surg Oncol. 2008 Sep;15(9):2472-81. doi: 10.1245/s10434-008-0023-y. Epub 2008 Jul 2.
This study sought to clarify the distribution of intrahepatic micrometastases and elucidate an adequate hepatectomy margin for colorectal carcinoma liver metastases.
Intrahepatic micrometastases in resected specimens from 90 patients who underwent hepatectomy for colorectal carcinoma liver metastases were examined retrospectively. Intrahepatic micrometastases were defined as microscopic lesions spatially separated from the gross tumor. Distances from these lesions to the hepatic tumor borders were measured histologically, and the density of intrahepatic micrometastases (number of lesions/mm(2)) calculated relative to the advancing tumor border in a zone <1 cm from the border (close) or >/=1 cm away (distant). Median follow-up time was 127 months.
A total of 294 intrahepatic micrometastases were detected in 52 (58%) patients; 95% of these occurred in the close zone. The density of intrahepatic micrometastases was significantly higher in the close zone (mean 74.8 x 10(-4 ) lesions/mm(2)) than in the distant zone (mean 7.4 x 10(-4 ) lesions/mm(2); P < 0.001). Hepatectomy margin status was positive by 0 cm in 10 patients or negative by <1 cm in 51, and by >/=1 cm in 29 patients. The median survival times were 18, 33, and 89 months in patients with hepatectomy margins 0 cm, <1 cm, and >/=1 cm, respectively. Hepatectomy margin status independently influenced survival (P < 0.001) and disease-free survival (P < 0.001).
The currently recommended >/=1 cm hepatectomy margin should remain the goal for resections of colorectal carcinoma liver metastases, based on the distribution of intrahepatic micrometastases and survival risk.
本研究旨在明确肝内微转移灶的分布情况，并阐明结直肠癌肝转移灶肝切除切缘的合适范围。
回顾性分析90例行结直肠癌肝转移灶肝切除术患者切除标本中的肝内微转移灶。肝内微转移灶定义为在空间上与大体肿瘤分离的微小病变。通过组织学方法测量这些病变距肝肿瘤边界的距离，并计算距边界<1 cm区域（近侧）或≥1 cm区域（远侧）内相对于肿瘤进展边界的肝内微转移灶密度（每平方毫米病变数）。中位随访时间为127个月。
52例（58%）患者共检测到294个肝内微转移灶；其中95%发生在近侧区域。近侧区域肝内微转移灶密度（平均74.8×10⁻⁴个病变/平方毫米）显著高于远侧区域（平均7.4×10⁻⁴个病变/平方毫米；P<0.001）。肝切除切缘状态为：10例患者切缘为0 cm阳性，51例患者切缘<1 cm阴性，29例患者切缘≥1 cm阴性。肝切除切缘分别为0 cm、<1 cm和≥1 cm的患者，其中位生存时间分别为18个月、33个月和89个月。肝切除切缘状态独立影响生存（P<0.001）和无病生存（P<0.001）。
基于肝内微转移灶的分布情况和生存风险，目前推荐的≥1 cm肝切除切缘应仍是结直肠癌肝转移灶切除术的目标。
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