Barts and The London HPB Unit, The Royal London Hospital, London, UK.
Am J Surg. 2012 Jun;203(6):691-7. doi: 10.1016/j.amjsurg.2011.07.014. Epub 2011 Dec 7.
The aim of this study was to analyze the feasibility and early outcomes of 2-stage liver resection for bilobar metastases.
Data from 39 consecutive patients undergoing 2-stage hepatectomy between 2004 and 2010 were prospectively collected.
The median age was 59 years (range, 33-79 years), and the ratio of men to women was 1.8:1. Metastases were colorectal carcinoma (n = 33), neuroendocrine tumors (n = 3), gastrointestinal stromal tumor (n = 1), ocular melanoma (n = 1), and salivary gland carcinoma (n = 1). Perioperative chemotherapy was given to 32 patients (82%). Twenty-nine patients (74%) underwent portal venous embolization. Radiofrequency ablation was used in 8 patients (21%). Twenty-seven patients (69%) successfully completed clearance. For the 1st and 2nd stages, the median lengths of stay were 11 days (range, 6-53 days) and 13 days (range, 6-44 days), and morbidity rates were 23% and 56%. Liver insufficiency occurred in 2 (5%) and 6 (22%) patients. Overall mortality was 2.6%. For colorectal metastases, median survival in successes versus failures was 24 versus 10 months (P = .03), and 3-year survival was 30% versus 0%.
Two-stage hepatectomy is feasible, with 69% of patients achieving clearance with low mortality. Morbidity is significant, particularly transient hepatic insufficiency.
本研究旨在分析两阶段肝切除术治疗双侧肝转移的可行性和早期结果。
前瞻性收集了 2004 年至 2010 年间连续 39 例接受两阶段肝切除术患者的数据。
中位年龄为 59 岁（范围 33-79 岁），男女比例为 1.8:1。转移灶为结直肠癌（n=33）、神经内分泌肿瘤（n=3）、胃肠道间质瘤（n=1）、眼部黑色素瘤（n=1）和唾液腺癌（n=1）。32 例患者（82%）接受了围手术期化疗。29 例患者（74%）接受了门静脉栓塞术。8 例患者（21%）采用射频消融术。27 例患者（69%）成功清除。第 1 期和第 2 期的中位住院时间分别为 11 天（范围 6-53 天）和 13 天（范围 6-44 天），发病率分别为 23%和 56%。2 例（5%）和 6 例（22%）患者发生肝功能不全。总死亡率为 2.6%。对于结直肠转移灶，成功组与失败组的中位生存时间分别为 24 个月与 10 个月（P=0.03），3 年生存率分别为 30%与 0%。
两阶段肝切除术是可行的，69%的患者成功清除肿瘤且死亡率低。发病率高，特别是短暂性肝功能不全。
