Takahashi K, Mori T, Takahashi T
Dept. of Surgery, Tokyo Metropolitan Komagome Hospital.
Gan To Kagaku Ryoho. 1991 Aug;18(11):1935-9.
We retrospectively evaluated continuous intra-arterial infusion chemotherapy after hepatic resection for hepatic metastases of colorectal cancer. From 1982 to 1990, we treated 22 patients with continuous intra-arterial infusion chemotherapy after hepatic resection, and 43 patients with only hepatic resection. 5-FU (250 mg/day) was administered continuously through implantable reservoir immediately after hepatic resection, and continued as long as possible. The total dose of 5-FU administered was 1.75-46.0 g (mean 17.4 g). We divided the patients into three groups: the first was administered a total dose of 5-FU more than 15 g, the next with less than 15 g, and the last with only hepatic resection was not given 5-FU. The 5-FU group receiving more than 15 g showed the lowest rate of hepatic metastasis recurrence. We compared the group showing recurrence within six months after hepatic resection (early recurrent group) with the group evidencing recurrence on and after six months (late recurrent group). In the former group, extra-hepatic recurrence significantly increased, whereas in the latter group hepatic recurrence significantly increased (p less than 0.05). In the early recurrent group, moderately or poorly differentiated adenocarcinoma significantly increased (p less than 0.01). According to the pathological result of pre-operative biopsy, one should check for extra-hepatic lesion as much as possible, and choose systemic chemotherapy for the early recurrent group.
我们回顾性评估了结直肠癌肝转移肝切除术后持续动脉内灌注化疗的情况。1982年至1990年,我们对22例肝切除术后的患者进行了持续动脉内灌注化疗,另有43例患者仅接受了肝切除。肝切除术后立即通过植入式储液器持续给予5-氟尿嘧啶(5-FU,250mg/天),并尽可能长时间持续给药。5-FU的总给药剂量为1.75-46.0g(平均17.4g)。我们将患者分为三组:第一组5-FU总剂量超过15g,第二组低于15g,最后一组仅接受肝切除未给予5-FU。接受超过15g 5-FU的组肝转移复发率最低。我们比较了肝切除术后6个月内出现复发的组(早期复发组)和6个月及以后出现复发的组(晚期复发组)。在前一组中,肝外复发显著增加,而在后一组中肝内复发显著增加(p<0.05)。在早期复发组中,中分化或低分化腺癌显著增加(p<0.01)。根据术前活检的病理结果,应尽可能检查肝外病变,并为早期复发组选择全身化疗。