Departments of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, UK.
Br J Surg. 2015 Feb;102(3):261-8. doi: 10.1002/bjs.9737. Epub 2014 Dec 22.
The most common sites of metastasis from colorectal cancer (CRC) are hepatic and pulmonary; they can present simultaneously (hepatic and pulmonary metastases) or sequentially (hepatic then pulmonary metastases, or vice versa). Simultaneous disease may be aggressive, and thus may be approached with caution by the clinician. The aim of this study was to determine the outcomes following hepatic and pulmonary resection for simultaneously presenting metastatic CRC.
A retrospective review was undertaken of a prospectively maintained database to identify patients presenting with simultaneous hepatopulmonary disease who underwent hepatic resection. Patients' electronic records were used to identify clinicopathological variables. The log rank test was used to determine survival, and χ(2) analysis to determine predictors of failure of intended treatment.
Fifty-nine patients were identified and underwent hepatic resection; median survival was 45·4 months and the 5-year survival rate 38 per cent. Twenty-two patients (37 per cent) did not have the intended pulmonary intervention owing to progression or recurrence of disease. Thirty-seven patients who progressed to hepatopulmonary resection had a median survival of 54·2 months (5-year survival rate 43 per cent). Those who had hepatic resection alone had a median survival of 24·0 months (5-year survival rate 30 per cent). Failure to progress to pulmonary resection was predicted by heavy nodal burden of primary colorectal disease and bilobar hepatic metastases. Redo pulmonary surgery following pulmonary recurrence did not confer a survival benefit.
Selected patients with simultaneous hepatopulmonary CRC metastases should be considered for attempted curative resection, but some patients may not receive the intended treatment owing to progression of pulmonary disease after hepatic resection.
结直肠癌（CRC）最常见的转移部位是肝脏和肺部；它们可以同时（肝肺转移）或先后（肝转移然后肺转移，或反之亦然）出现。同时存在的疾病可能具有侵袭性，因此临床医生可能会谨慎处理。本研究旨在确定同时存在转移性 CRC 患者行肝肺切除术后的结果。
对前瞻性维护的数据库进行回顾性分析，以确定同时存在肝肺疾病并接受肝切除术的患者。使用患者的电子病历来识别临床病理变量。对数秩检验用于确定生存情况，χ²分析用于确定治疗失败的预测因素。
共确定 59 例患者并接受了肝切除术；中位生存时间为 45.4 个月，5 年生存率为 38%。由于疾病进展或复发，22 例（37%）患者未进行预期的肺部介入。37 例进展为肝肺切除术的患者中位生存时间为 54.2 个月（5 年生存率为 43%）。仅行肝切除术的患者中位生存时间为 24.0 个月（5 年生存率为 30%）。未能进展为肺切除术与结直肠原发疾病的淋巴结受累严重和肝内多发病灶有关。肺复发后再次进行肺切除术并不能带来生存获益。
对于同时存在肝肺 CRC 转移的选定患者，应考虑尝试根治性切除，但由于肝切除后肺部疾病进展，有些患者可能无法接受预期的治疗。
