Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, 66421, Homburg/Saar, Germany.
Langenbecks Arch Surg. 2012 Mar;397(3):383-95. doi: 10.1007/s00423-011-0872-x. Epub 2011 Nov 17.
Hepatic resection of colorectal liver metastases is the only curative treatment option. As clinical and experimental data indicate that the extent of liver resection correlates with growth of residual metastases, the present study analyzes the potential benefit of a parenchyma-preserving liver surgery approach.
Data from a prospectively maintained database of patients undergoing liver resection for colorectal metastases were reviewed. Evaluation of outcome was performed using the Kaplan-Meier method. Correlations were calculated between clinical-pathological variables.
One hundred sixty-three patients underwent 198 liver resections for colorectal metastases: 26 major hepatectomies, 65 minor anatomical resections, 78 non-anatomical resections, as well as 29 combinations of minor anatomical and non-anatomical procedures. Overall 1-, 3-, and 5-year survival was 93%, 62%, and 40%, respectively. Patients with repeated liver resections had a 5-year survival of 27%. Interestingly, large dissection areas were associated with a significant reduction of the 5-year survival rate (33%). Five-year survival after major hepatectomy was not significantly reduced.
For colorectal liver metastases, minor resections offer a prolonged survival compared to major hepatectomies. As patients with stage IV colorectal disease are candidates for repeat resections, preservation of hepatic parenchyma is of increasing importance in the setting of multi-modal and repeated therapy approaches.
结直肠肝转移的肝切除术是唯一的治愈性治疗选择。由于临床和实验数据表明肝切除的范围与残留转移灶的生长相关，本研究分析了保留肝实质的肝手术方法的潜在益处。
回顾了接受结直肠转移肝切除术的前瞻性维护数据库中的患者数据。使用 Kaplan-Meier 方法评估预后。计算了临床病理变量之间的相关性。
163 例患者接受了 198 例结直肠转移的肝切除术：26 例大肝切除术、65 例小解剖性切除术、78 例非解剖性切除术，以及 29 例小解剖性和非解剖性联合手术。总体 1、3 和 5 年生存率分别为 93%、62%和 40%。重复肝切除术患者的 5 年生存率为 27%。有趣的是，大解剖面积与 5 年生存率显著降低相关（33%）。大肝切除术后 5 年生存率无显著降低。
对于结直肠肝转移，与大肝切除术相比，小切除术提供了更长的生存时间。由于 IV 期结直肠癌患者是重复切除的候选者，在多模式和重复治疗方法的背景下，保留肝实质对于患者越来越重要。
