Wolf R F, Goodnight J E, Krag D E, Schneider P D
Department of Surgery, University of California, Davis Medical Center, Sacramento 95817.
Surg Gynecol Obstet. 1991 Dec;173(6):454-60.
Resection of hepatic metastases from carcinomas of the colon and rectum appears to extend the survival time in appropriately selected patients. Selection criteria have been widely published. Similar data for patients with hepatic metastases from primary sites other than the colon and rectum are lacking. To determine which, if any, patients in the latter category benefit from resections, we reviewed ten such instances treated at our institution plus 141 instances of resection for noncolorectal hepatic metastases previously reported. The over-all five year survival rate after resection of noncolorectal hepatic metastases is 20 per cent. When Wilms' tumor is excluded, the five year survival rate is 15 per cent. Approximately four of ten patients with metastases to the liver from Wilms' tumor or carcinoid survived five years after resection. Similar benefit is rarely obtained after resection of hepatic metastases of the breast, kidney, adrenal gland and carcinomas of the stomach; malignant melanoma, and leiomyosarcoma. No extension of survival is apparent for resection of hepatic metastases of gynecologic malignancies or carcinoma of the pancreas. Specific guidelines for selection are discussed in view of the limited prognosis when tumors other than carcinomas of the colon and rectum metastasize to the liver. Careful patient selection and minimization of complications are required.
对结肠癌和直肠癌肝转移灶进行切除似乎能延长经过适当挑选患者的生存时间。挑选标准已广泛发表。目前缺乏关于结肠和直肠以外原发部位肝转移患者的类似数据。为了确定后一类患者中哪些（如果有的话）能从切除术中获益，我们回顾了在我们机构治疗的10例此类病例以及之前报道的141例非结直肠肝转移切除术病例。非结直肠肝转移灶切除术后的总体五年生存率为20%。排除肾母细胞瘤后，五年生存率为15%。肾母细胞瘤或类癌肝转移的患者中，约十分之四在切除术后存活了五年。乳腺癌、肾癌、肾上腺癌、胃癌、恶性黑色素瘤和平滑肌肉瘤肝转移灶切除术后很少能获得类似的益处。妇科恶性肿瘤或胰腺癌肝转移灶切除术后未见生存延长。鉴于结肠和直肠癌以外的肿瘤转移至肝脏时预后有限，讨论了具体的挑选指南。需要仔细挑选患者并尽量减少并发症。
