Lee Huisong, Choi Dong Wook, Cho Yong Beom, Yun Seong Hyeon, Kim Hee Cheol, Lee Woo Yong, Heo Jin Seok, Choi Seong Ho, Jung Kyung Uk, Chun Ho-Kyung
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Surg Oncol. 2014 May;21(5):1641-6. doi: 10.1245/s10434-013-3477-5. Epub 2014 Feb 5.
The veins from the lower rectum drain into the systemic venous system, while those from other parts of the colon drain into the portal venous system. The aim of this study was to investigate recurrence pattern and survival according to the anatomical differences in patients with colorectal liver metastases (CRLM).
From October 1994 to December 2009, synchronous CRLM patients who underwent surgery were identified from our prospectively collected database. The patients were excluded if there had been extrahepatic metastases. The patients were divided into two groups according to the location of the primary colorectal cancer: lower rectal cancer (group 1) and upper rectal or colon cancer (group 2). The recurrence patterns and survival were investigated.
A total of 316 patients were included: 53 patients in group 1 and 263 patients in group 2. After a median follow-up of 37 months, the extrahepatic recurrence curve of group 1 was superior to that of group 2 (P < 0.001), although there was no difference between the hepatic recurrence curves (P = 0.93). The disease-free and overall survival curves of group 1 were inferior to those of group 2 (P = 0.004) (P < 0.001). Lower rectal cancer was a significant risk factor for extrahepatic recurrence in Cox proportional hazard model analysis (hazard ratio = 1.7, P = 0.04).
The extrahepatic recurrence rate is high in lower rectal cancer patients after surgical treatment for synchronous CRLM.
直肠下段的静脉汇入体循环静脉系统，而结肠其他部位的静脉汇入门静脉系统。本研究的目的是根据结直肠癌肝转移（CRLM）患者的解剖学差异，探讨复发模式和生存率。
从1994年10月至2009年12月，从我们前瞻性收集的数据库中识别出接受手术的同步CRLM患者。如果存在肝外转移，则排除这些患者。根据原发性结直肠癌的位置将患者分为两组：直肠下段癌（第1组）和直肠上段或结肠癌（第2组）。研究复发模式和生存率。
共纳入316例患者：第1组53例，第2组263例。中位随访37个月后，第1组的肝外复发曲线优于第2组（P < 0.001），尽管肝内复发曲线之间无差异（P = 0.93）。第1组的无病生存曲线和总生存曲线低于第2组（P = 0.004）（P < 0.001）。在Cox比例风险模型分析中，直肠下段癌是肝外复发的显著危险因素（风险比 = 1.7，P = 0.04）。
同步CRLM手术治疗后，直肠下段癌患者的肝外复发率较高。
