Ercolani G, Vetrone G, Grazi G L, Cescon M, Di Gioia P, Ravaioli M, Del Gaudio M, Tuci F, Zanello M, Cucchetti A, D Pinna A
Department of Emergency, Surgery and Transplants, General Surgery and Transplant Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Minerva Chir. 2009 Dec;64(6):551-8.
The aim of this study was to evaluate the role of surgery in the treatment of non-colorectal, non-neuroendocrine (NCRNNE) liver metastases.
One hundred and thirty-four patients undergoing curative liver resection for NCRNNE liver metastases were retrospectively analyzed. Perioperative results (blood transfusion, hospital stay, morbidity and mortality), 3 and 5-year overall and disease-free survival were evaluated. The following prognostic factors were analyzed: age (cut-off 50 year old), single vs. multiple nodules, diameter (cut-off 5 cm), disease-free interval less vs. more than one year, type of primary tumor, blood transfusion, major hepatectomy vs. minor hepatectomy. Survival of patients undergoing liver resection for metastatic colorectal cancer was also analyzed to compare the results with the study population.
Mortality and morbidity rate were 3% and 23.1%, respectively. The 3 and 5-year survival were 56.5% and 40%, respectively. The 3 and 5-year disease-free survival were 44% and 30%, respectively. Diameter, disease-free interval and metastases from gastrointestinal cancers were independently related to the survival at the multivariate analysis. Thirty-nine patients (27%) survived over five years. Patients with liver metastases from gastrointestinal primary tumors were those with a worse survival (25% and 19% at 3 and 5 years, respectively).
Surgery is an effective treatment for patients with NCRNNE liver metastases, providing satisfactory long-term outcomes with acceptable morbidity and mortality, in particular when excluding patients with gastro-intestinal metastases.
本研究旨在评估手术在非结直肠癌、非神经内分泌(NCRNNE)肝转移瘤治疗中的作用。
对134例行根治性肝切除术治疗NCRNNE肝转移瘤的患者进行回顾性分析。评估围手术期结果(输血、住院时间、发病率和死亡率)、3年和5年总生存率及无病生存率。分析以下预后因素:年龄(分界值50岁)、单发病灶与多发病灶、直径(分界值5 cm)、无病间期小于1年与大于1年、原发肿瘤类型、输血情况、大肝切除术与小肝切除术。还分析了行肝切除术治疗转移性结直肠癌患者的生存率,以便与研究人群的结果进行比较。
死亡率和发病率分别为3%和23.1%。3年和5年生存率分别为56.5%和40%。3年和5年无病生存率分别为44%和30%。在多变量分析中,直径、无病间期和胃肠道癌转移与生存率独立相关。39例患者(27%)存活超过5年。胃肠道原发性肿瘤肝转移患者的生存率较差(3年和5年分别为25%和19%)。
手术是治疗NCRNNE肝转移瘤患者的有效方法,可提供令人满意的长期疗效,且发病率和死亡率可接受,尤其是排除胃肠道转移患者时。