Hughes K S, Rosenstein R B, Songhorabodi S, Adson M A, Ilstrup D M, Fortner J G, Maclean B J, Foster J H, Daly J M, Fitzherbert D
Division of Surgical Oncology, UCD Medical Center, Sacramento 95817.
Dis Colon Rectum. 1988 Jan;31(1):1-4. doi: 10.1007/BF02552560.
In this review of a collected series of patients undergoing hepatic resection for colorectal metastases, 100 patients were found to have survived greater than five years from the time of resection. Of these 100 long-term survivors, 71 remain disease-free through the last follow-up, 19 recurred prior to five years, and ten recurred after five years. Patient characteristics that may have contributed to survival were examined. Procedures performed included five trisegmentectomies, 32 lobectomies, 16 left lateral segmentectomies, and 45 wedge resections. The margin of resection was recorded in 27 patients, one of whom had a positive margin, nine of whom had a less than or equal to 1-cm margin, and 17 of whom had a greater than 1-cm margin. Eighty-one patients had a solitary metastasis to the liver, 11 patients had two metastases, one patient had three metastases, and four patients had four metastases. Thirty patients had Stage C primary carcinoma, 40 had Stage B primary carcinoma, and one had Stage A primary carcinoma. The disease-free interval from the time of colon resection to the time of liver resection was less than one year in 65 patients, and greater than one year in 34 patients. Three patients had bilobar metastases. Four of the patients had extrahepatic disease resected simultaneously with the liver resection. Though several contraindications to hepatic resection have been proposed in the past, five-year survival has been found in patients with extrahepatic disease resected simultaneously, patients with bilobar metastases, patients with multiple metastases, and patients with positive margins. Five-year disease-free survivors are also present in each of these subsets. It is concluded that five-year survival is possible in the presence of reported contraindications to resection, and therefore that the decision to resect the liver must be individualized.
在本次对一系列接受肝切除治疗结直肠癌肝转移患者的回顾中，发现有100例患者自切除术后存活超过五年。在这100例长期存活者中，71例在最后一次随访时仍无疾病复发，19例在五年前复发，10例在五年后复发。研究了可能有助于存活的患者特征。所实施的手术包括5例三段切除术、32例肝叶切除术、16例左外叶切除术和45例楔形切除术。记录了27例患者的切除切缘情况，其中1例切缘阳性，9例切缘小于或等于1厘米，17例切缘大于1厘米。81例患者肝脏有单个转移灶，11例有两个转移灶，1例有三个转移灶，4例有四个转移灶。30例患者原发性癌为C期，40例为B期，1例为A期。65例患者从结肠切除到肝切除的无病间期小于一年，34例大于一年。3例患者有双侧肝转移。4例患者在肝切除同时切除了肝外病变。尽管过去曾提出过一些肝切除的禁忌证，但在同时切除肝外病变的患者、双侧肝转移患者、多发转移患者和切缘阳性的患者中均发现了五年生存率。这些亚组中也都有无病生存五年的患者。结论是，在存在已报道的切除禁忌证的情况下仍有可能实现五年生存率，因此肝切除的决策必须个体化。
