Tanaka Kuniya, Matsuyama Ryusei, Takeda Kazuhisa, Matsuo Kenichi, Nagano Yasuhiko, Endo Itaru
Kuniya Tanaka, Ryusei Matsuyama, Kazuhisa Takeda, Kenichi Matsuo, Yasuhiko Nagano, Itaru Endo, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan.
World J Hepatol. 2009 Oct 31;1(1):79-89. doi: 10.4254/wjh.v1.i1.79.
To clarify short- and long-term outcomes of combined resection of liver with major vessels in treating colorectal liver metastases.
Clinicopathologic data were evaluated for 312 patients who underwent 371 liver resections for metastases from colorectal cancer. Twenty-five patients who underwent resection and reconstruction of retrohepatic vena cava, major hepatic veins, or hepatic venous confluence during hepatectomies were compared with other patients, who underwent conventional liver resections.
Morbidity was 20% (75/371) and mortality was 0.3% (1/312) in all patients after hepatectomy. Hepatic resection combined with major-vessel resection/reconstruction could be performed with acceptable morbidity (16%) and no mortality. By multivariate analysis, repeat liver resection (relative risk or RR, 5.690; P = 0.0008) was independently associated with resection/reconstruction of major vessels during hepatectomy, as were tumor size exceeding 30 mm (RR, 3.338; P = 0.0292) and prehepatectomy chemotherapy (RR, 3.485; P = 0.0083). When 312 patients who underwent a first liver resection for initial liver metastases were divided into those with conventional resection (n = 296) and those with combined resection of liver and major vessels (n = 16), overall survival and disease-free rates were significantly poorer in the combined resection group than in the conventional resection group (P = 0.02 and P < 0.01, respectively). A similar tendency concerning overall survival was observed for conventional resection (n = 37) vs major-vessel resection combined with liver resection (n = 7) performed as a second resection following liver recurrences (P = 0.09). Combined major-vessel resection at first hepatectomy (not performed; 0.512; P = 0.0394) and histologic major-vessel invasion at a second hepatectomy (negative; 0.057; P = 0.0005) were identified as independent factors affecting survival by multivariate analysis.
Hepatic resection including major-vessel resection/reconstruction for colorectal liver metastases can be performed with acceptable operative risk. However, such aggressive approaches are beneficial mainly in patients responding to effective prehepatectomy chemotherapy.
阐明联合切除肝脏及主要血管治疗结直肠癌肝转移的短期和长期疗效。
对312例行371次肝脏转移瘤切除术的患者的临床病理资料进行评估。将25例在肝切除术中进行肝后腔静脉、主要肝静脉或肝静脉汇合处切除及重建的患者与其他行常规肝切除术的患者进行比较。
所有患者肝切除术后的发病率为20%（75/371），死亡率为0.3%（1/312）。肝切除联合主要血管切除/重建的手术发病率可接受（16%），且无死亡病例。多因素分析显示，再次肝切除（相对危险度或RR，5.690；P = 0.0008）与肝切除术中主要血管的切除/重建独立相关，肿瘤大小超过30 mm（RR，3.338；P = 0.0292）和肝切除术前化疗（RR，3.485；P = 0.0083）也与之相关。当将312例因初始肝转移行首次肝切除术的患者分为常规切除术组（n = 296）和肝与主要血管联合切除术组（n = 16）时，联合切除术组的总生存率和无病生存率显著低于常规切除术组（分别为P = 0.02和P < 0.）。对于肝复发后作为第二次切除术进行的常规切除术（n = 37）与主要血管切除术联合肝切除术（n = 7），在总生存方面也观察到类似趋势（P = 0.09）。多因素分析确定首次肝切除时联合主要血管切除术（未进行；0.512；P = 0.0394）和第二次肝切除时组织学上主要血管侵犯（阴性；0.057；P = 0.0005）为影响生存的独立因素。
包括主要血管切除/重建的肝切除术治疗结直肠癌肝转移，手术风险可接受。然而，这种积极的方法主要对肝切除术前化疗有效的患者有益。
