Lefor A T, Hughes K S, Shiloni E, Steinberg S M, Vetto J T, Papa M Z, Sugarbaker P H, Chang A E
Surgery Branch, National Cancer Institute, Bethesda, Maryland 20892.
Dis Colon Rectum. 1988 Feb;31(2):100-3. doi: 10.1007/BF02562637.
The resection of hepatic metastases in patients with extrahepatic disease is of no proven benefit. Preoperative identification of extrahepatic disease may prevent unnecessary laparotomy. Preoperative evaluation including physical examination, computed tomography of the abdomen, full lung tomography or chest-computed tomography, and radionuclide bone scanning identified extrahepatic metastases, most commonly in the lung, in 25 of 132 patients with purported isolated liver metastases. Of 107 patients with negative staging evaluations, intra-abdominal extrahepatic metastases were found in 26 percent (28 of 107) at laparotomy, most commonly in portal and celiac lymph nodes. The presence of extrahepatic disease correlated with greater than 25 percent hepatic replacement by tumor, presence of symptoms, and Dukes' C primary lesions; however, none was predictive. We were unable to develop a model to preoperatively predict the presence of intra-abdominal extrahepatic disease. The authors recommend a preoperative evaluation including physical examination, and computed tomographic scans of the abdomen and chest. A bone scan is required only in patients with symptoms referable to bone. Despite a negative preoperative evaluation, however, a considerable proportion of patients with colorectal hepatic metastases will have extrahepatic disease at the time of abdominal exploration.
对于伴有肝外疾病的患者，切除肝转移灶并未被证实有益。术前识别肝外疾病可避免不必要的剖腹手术。术前评估包括体格检查、腹部计算机断层扫描、全肺断层扫描或胸部计算机断层扫描以及放射性核素骨扫描，在132例据称孤立性肝转移患者中，有25例发现了肝外转移，最常见于肺部。在107例分期评估为阴性的患者中，剖腹手术时发现26%（107例中的28例）存在腹腔内肝外转移，最常见于门静脉和腹腔淋巴结。肝外疾病的存在与肿瘤替代肝脏超过25%、症状的出现以及Dukes C期原发性病变相关；然而，没有一项具有预测性。我们无法建立一个术前预测腹腔内肝外疾病存在的模型。作者建议术前评估包括体格检查以及腹部和胸部的计算机断层扫描。仅在有骨相关症状的患者中需要进行骨扫描。然而，尽管术前评估为阴性，但相当一部分结直肠癌肝转移患者在腹部探查时仍会有肝外疾病。
