Vyslouzil K, Klementa I, Starý L, Zboril P, Skalický P, Dlouhý M, Cwiertka K, Duda M
II. Klinik für Chirurgie, Fakultätskrankenhaus und Medizinische Fakultät der Palacký-Universität Olomouc.
Zentralbl Chir. 2009 Apr;134(2):145-8. doi: 10.1055/s-2008-1076874. Epub 2009 Apr 20.
Liver resection is the preferred treatment for colorectal liver metastases. About 30 to 40 % of the patients survive for five years after radical resection of liver metastases. In contrast to that, patients who are not fit enough for radical resection of metastases and two are treated by chemotherapy survive only for 18 months on average. The survival of patients with non-resectable liver metastases can be improved by metastases destruction and subsequent chemotherapy. At present, radiofrequency ablation (RFA) is widely used for the destruction of liver tumours.
In the four-year period (2000-2003), 190 patients with liver metastases of colorectal carcinoma have been operated upon at the 2 (nd) Surgical Department of University Hospital in Olomouc. Radical resection of metastases was carried out in 136 patients (71.5 %), RFA combined with liver resection was performed in 23 patients (12 %) and exclusive RFA of metastases was indicated in 31 patients (16 %). The patients were evaluated for the disease-free survival after one year and the survival rates at 12, 24 and 36 months after operation were determined.
12 months after the operation no tumour progression was found in 115 patients (85 %) subjected to radical resection of liver metastases, in 16 patients (52 %) after sole RFA of metastases and in 15 individuals (65 %) who underwent liver metastasis resection combined with RFA of the remaining cancer foci. The survival of patients after 12, 24 and 36 months was 124 / 136 (91 %) 103 / 136 (76 %) and 79 / 136 (58 %) in the group of radical metastasis resection; after sole RFA of the metastases and subsequent chemotherapy, the survival at 12, 24 and 36 months amounted to 27 / 31 (87 %), 19 / 31 (61 %) and 8 / 31 (26 %) of the patients; in the group undergoing metastases resection combined with RFA and adjuvant chemotherapy patient survival at 12, 24 and 36 months was as follows: 19 / 23 (83 %), 13 / 23 (57 %), and 7 / 23 (30 %).
RFA combined with adjuvant chemotherapy considerably extends the survival of patients with liver metastases of colorectal carcinoma compared to chemotherapy alone. However, no difference in survival was found between our patients subjected to RFA of metastases and adjuvant chemotherapy and those patients undergoing resection of liver metastases combined with RFA of unresectable metastases and subsequent chemotherapy.
肝切除术是治疗结直肠癌肝转移的首选方法。约30%至40%的患者在肝转移灶根治性切除术后能存活五年。相比之下，那些身体状况不适合进行转移灶根治性切除且接受化疗的患者平均仅存活18个月。不可切除的肝转移患者的生存率可通过转移灶毁损及后续化疗得到提高。目前，射频消融（RFA）被广泛用于肝肿瘤的毁损。
在四年期间（2000 - 2003年），奥洛穆茨大学医院第二外科对190例结直肠癌肝转移患者进行了手术。136例患者（71.5%）进行了转移灶的根治性切除，23例患者（12%）进行了RFA联合肝切除术，31例患者（16%）仅进行了转移灶的RFA。对患者进行了一年后的无病生存期评估，并确定了术后12、24和36个月的生存率。
肝转移灶根治性切除术后，115例患者（85%）在术后12个月未发现肿瘤进展；仅行转移灶RFA术后，16例患者（52%）未发现肿瘤进展；行肝转移灶切除联合剩余癌灶RFA术后，15例患者（65%）未发现肿瘤进展。根治性转移灶切除组患者术后12、24和36个月的生存率分别为124 / 136（91%）、103 / 136（76%）和79 / 136（58%）；仅行转移灶RFA及后续化疗的患者，术后12、24和36个月的生存率分别为27 / 31（87%）、19 / 31（61%）和8 / 31（26%）；行转移灶切除联合RFA及辅助化疗组患者术后12、24和36个月的生存率如下：19 / 23（83%）、13 / 23（57%）和7 / 23（30%）。
与单纯化疗相比，RFA联合辅助化疗显著延长了结直肠癌肝转移患者的生存期。然而，我们的转移灶RFA及辅助化疗患者与行肝转移灶切除联合不可切除转移灶RFA及后续化疗的患者在生存率上未发现差异。
