对不可切除的双侧结直肠癌肝转移患者采用两阶段肝切除术联合选择性门静脉栓塞及全身化疗的前瞻性评估。
Prospective evaluation of two-stage hepatectomy combined with selective portal vein embolisation and systemic chemotherapy for patients with unresectable bilobar colorectal liver metastases.
作者信息
Pamecha V, Nedjat-Shokouhi B, Gurusamy K, Glantzounis G K, Sharma D, Davidson B R
机构信息
Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Hospital, and Royal Free University College Medical School, University College London, London, UK.
出版信息
Dig Surg. 2008;25(5):387-93. doi: 10.1159/000176063. Epub 2008 Nov 26.
BACKGROUND
Liver resection is contraindicated in patients with multiple bilobar colorectal liver metastases because of the small liver remnant. An alternative strategy which may be curative is a two-stage hepatectomy in which the cancer is resected from one lobe and regeneration allowed prior to contralateral lobe resection.
OBJECTIVE
To assess the feasibility, risks, and outcomes in a prospectively applied strategy for two-stage hepatectomy.
METHODS
Over a 6-year period, 14 of 280 patients undergoing liver resection for colorectal liver metastases (5%) were considered for two-stage hepatectomy. Surgery was combined with chemotherapy in all (n = 14) and portal vein embolisation (PVE) selectively (n = 5). Median follow-up was 43 months.
RESULTS
Both stages were completed in 11 of 14 patients (78%). There were no deaths. Post-operative complication rates were 0% (1st hepatectomy) and 27% (2nd hepatectomy). The 5-year survival after the second hepatectomy was 50%. The mean disease-free survival was 25 +/- 7.5 months.
CONCLUSION
Two-stage hepatectomy combined with systemic chemotherapy and PVE can produce long-term survival in patients with multiple bilobar colorectal liver metastases.
背景
由于剩余肝脏过小，多叶结直肠癌肝转移患者禁忌行肝切除术。一种可能治愈的替代策略是两阶段肝切除术，即先从一个肝叶切除肿瘤，待其再生后再行对侧肝叶切除。
目的
评估前瞻性应用两阶段肝切除术策略的可行性、风险及结果。
方法
在6年期间，280例行结直肠癌肝转移肝切除术的患者中有14例（5%）考虑行两阶段肝切除术。所有患者（n = 14）手术均联合化疗，5例患者选择性行门静脉栓塞术（PVE）。中位随访时间为43个月。
结果
14例患者中有11例（78%）完成了两个阶段的手术。无死亡病例。术后并发症发生率第一阶段肝切除术为0%，第二阶段肝切除术为27%。第二次肝切除术后5年生存率为50%。平均无病生存期为25±7.5个月。
结论
两阶段肝切除术联合全身化疗和PVE可使多叶结直肠癌肝转移患者获得长期生存。
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