Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
J Gastrointest Surg. 2012 Jun;16(6):1171-80. doi: 10.1007/s11605-012-1840-7. Epub 2012 Feb 28.
When hepatectomy is used as a primary treatment for liver metastasis from colorectal cancer (CRCLM), the balance between surgical curability and functional preservation of the remnant liver is of great importance.
A total of 108 patients who underwent initial hepatectomy for CRCLM were retrospectively analyzed with respect to tumor extent, operative method, and prognosis, including recurrence.
The 1-, 2-, 3-, and 5-year overall survival rates (OS) for all patients were 90.5%, 77.8%, 63.2%, and 51.6%, respectively. Multivariate analysis indicated serum carbohydrate antigen 19-9 (CA 19-9) level after hepatectomy (<36 or ≥36 mAU/mL) and presence of recurrence as independent prognostic factors of OS (P = 0.0458 and 0.0249, respectively), and tumor depth of colorectal cancer (<se (a2) vs. ≥se (a2)) and serum CA 19-9 level after hepatectomy as the significant factors affecting disease-free survival (DFS) (P = 0.0025 and 0.00138, respectively). Neither resection margin nor type of hepatectomy (anatomic or nonanatomic) for CRCLM was a significant prognostic factor for OS or DFS or CRCLM recurrence, including intrahepatic recurrence.
In CRCLM, we believe that nonanatomic hepatectomy with narrow margin is indicated, and optimal treatment would include functional preservation of as much of the remnant liver as possible.
当肝切除术被用作结直肠癌肝转移（CRCLM）的主要治疗方法时，手术的可治愈性和残肝功能的保留之间的平衡非常重要。
回顾性分析了 108 例接受初始肝切除术治疗 CRCLM 的患者的肿瘤范围、手术方法和预后，包括复发情况。
所有患者的 1、2、3 和 5 年总生存率（OS）分别为 90.5%、77.8%、63.2%和 51.6%。多因素分析表明，肝切除术后血清碳水化合物抗原 19-9（CA 19-9）水平（<36 或≥36 mAU/mL）和存在复发是 OS 的独立预后因素（P=0.0458 和 0.0249），而结直肠癌的肿瘤深度（<se（a2）与≥se（a2））和肝切除术后的血清 CA 19-9 水平是影响无病生存（DFS）的显著因素（P=0.0025 和 0.00138）。对于 OS、DFS 或 CRCLM 复发，包括肝内复发，CRCLM 的切缘或肝切除术类型（解剖性或非解剖性）均不是显著的预后因素。
在 CRCLM 中，我们认为应采用非解剖性肝切除术并保留狭窄的切缘，最佳治疗方法是尽可能保留残肝的功能。
