Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun, Jeonnam, South Korea.
J Gastrointest Surg. 2010 Aug;14(8):1258-64. doi: 10.1007/s11605-010-1250-7. Epub 2010 Jun 11.
This study was designed to evaluate the impact of resection for primary colorectal cancer on oncologic outcomes in patients with synchronous colorectal liver metastases.
A retrospective analysis was performed on 91 consecutive patients with synchronous colorectal liver metastases who underwent resection of the primary colorectal cancer between December 1999 and December 2007. Of the 91 patients, 54 (59.3%) also underwent complete (R0) resection for liver metastases, and 84 (92.3%) received postoperative chemotherapy. The oncologic outcomes and prognostic factors were analyzed.
Operative mortality was 1.1%, and morbidity was 37.4%. The 3- and 5-year overall survival rates were 44.5% and 26.8%, respectively. A multivariate analysis revealed that residual disease after surgery (non-R0 resection; p = 0.003), lymph node metastasis of the primary tumor (p = 0.015), and no postoperative chemotherapy (p = 0.001) were independent prognostic factors for poor survival. Independent predictors of an inability to achieve a complete resection were the presence of three or more liver metastases and the presence of extrahepatic disease at exploration. Significant differences in survival existed among the three risk stratification groups (no-, low-, and high-risk groups; p < 0.001).
The inability to safely render the liver and colon microscopically free of disease should cause a surgeon to reconsider synchronous colectomy and hepatectomy. A multidisciplinary approach that combines both complete resection of synchronous colorectal liver metastases and postoperative chemotherapy may achieve improved survival in patients with synchronous colorectal liver metastases.
本研究旨在评估原发性结直肠癌切除术对同时性结直肠肝转移患者肿瘤学结局的影响。
对 1999 年 12 月至 2007 年 12 月期间接受原发性结直肠癌切除术的 91 例同时性结直肠肝转移患者进行回顾性分析。在这 91 例患者中，54 例（59.3%）患者还接受了完全（R0）肝转移切除术，84 例（92.3%）患者接受了术后化疗。分析了肿瘤学结果和预后因素。
手术死亡率为 1.1%，发病率为 37.4%。3 年和 5 年总生存率分别为 44.5%和 26.8%。多因素分析显示，术后残留疾病（非 R0 切除术；p = 0.003）、原发肿瘤淋巴结转移（p = 0.015）和无术后化疗（p = 0.001）是生存不良的独立预后因素。无法实现完全切除的独立预测因素是存在 3 个或更多肝转移灶和探查时存在肝外疾病。三种风险分层组（无风险、低风险和高风险组；p < 0.001）之间的生存存在显著差异。
无法安全地使肝脏和结肠显微镜下无疾病应促使外科医生重新考虑同时性结肠切除术和肝切除术。多学科方法结合完全切除同时性结直肠肝转移和术后化疗可能会提高同时性结直肠肝转移患者的生存率。
