Department of Laparoscopy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
Chin Med J (Engl). 2012 Mar;125(5):747-51.
Many studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastric cancer. However, indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined. This study was performed to assess the benefits and limits of simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases, as well as to identify prognostic factors affecting the survival.
Between January 2005 and June 2008, 13 patients with synchronous hepatic metastases underwent simultaneous combined resection. The clinicopathologic features and the surgical results of the 13 patients were retrospectively analyzed. Patient, tumor (primary and metastatic carcinoma), and operative parameters were analyzed for their influence on survival.
No patient died and two patients (15.4%) developed complications during peri-operative course. The actuarial 6-month, 1-year, and 2-year survival rates after hepatic resection were 76.9%, 38.5%, and 30.8%, respectively, and two patients survived for more than 2 years after surgery without any signs of recurrences until latest follow-up. In univariate analysis, hepatic tumor distribution (P=0.01) and number of hepatic metastases (P=0.003) were significant prognostic factors that influenced survival. Factors associated with the primary lesion were not significant prognostic factors.
Satisfactory survival may be achieved by simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases in strictly selected patients. The number of hepatic metastases and hepatic tumor distribution are significant prognostic determinants of survival.
许多研究报告了肝切除术对胃癌单发和异时性转移的益处。然而，对于胃癌同时性肝转移的适应证和手术结果尚未明确界定。本研究旨在评估同时联合切除原发胃癌和同时性肝转移的益处和局限性，并确定影响生存的预后因素。
2005 年 1 月至 2008 年 6 月，13 例同时性肝转移患者接受了同时联合切除。回顾性分析了 13 例患者的临床病理特征和手术结果。分析了患者、肿瘤（原发和转移性癌）和手术参数对生存的影响。
无患者在围手术期死亡，有 2 例（15.4%）患者发生并发症。肝切除术后 6 个月、1 年和 2 年的累积生存率分别为 76.9%、38.5%和 30.8%，术后有 2 例患者存活超过 2 年，且在随访期间没有任何复发迹象。单因素分析显示，肝肿瘤分布（P=0.01）和肝转移灶数目（P=0.003）是影响生存的显著预后因素。与原发灶相关的因素不是显著的预后因素。
在严格选择的患者中，同时联合切除原发胃癌和同时性肝转移可获得令人满意的生存。肝转移灶数目和肝肿瘤分布是影响生存的重要预后决定因素。
