Iwatsuki S, Esquivel C O, Gordon R D, Starzl T E
Surgery. 1986 Oct;100(4):804-10.
From 1975 to 1985, 60 patients with isolated hepatic metastases from colorectal cancer were treated by 17 right trisegmentectomies, five left trisegmentectomies, 20 right lobectomies, seven left lobectomies, eight left lateral segmentectomies, and three nonanatomic wedge resections. The 1-month operative mortality rate was 0%. One- to 5-year actuarial survival rates of the 60 patients were 95%, 72%, 53%, 45%, and 45%, respectively. The survival rate after liver resection was the same when solitary lesions were compared with multiple lesions. However, none of the seven patients with four or more lesions survived 3 years. The interval after colorectal resection did not influence the survival rate after liver resection, and survival rates did not differ statistically when synchronous metastases were compared with metachronous tumors. A significant survival advantage of patients with Dukes' B primary lesions was noted when compared with Dukes' C and D lesions. The pattern of tumor recurrence after liver resection appeared to be systemic rather than hepatic. The patients who received systemic chemotherapy before clinical evidence of tumor recurrence after liver resection survived longer than those who did not.
1975年至1985年期间，60例结直肠癌孤立性肝转移患者接受了手术治疗，其中17例行右三叶切除术，5例行左三叶切除术，20例行右半肝切除术，7例行左半肝切除术，8例行左外叶切除术，3例行非解剖性楔形切除术。1个月手术死亡率为0%。这60例患者1年、5年的精算生存率分别为95%、72%、53%、45%和45%。孤立性病变与多发性病变患者肝切除术后的生存率相同。然而，7例有4个或更多病变的患者中无一例存活3年。结直肠切除术后的间隔时间不影响肝切除术后的生存率，同时性转移与异时性肿瘤相比，生存率在统计学上无差异。与Dukes' C期和D期病变相比，Dukes' B期原发性病变患者具有显著的生存优势。肝切除术后肿瘤复发模式似乎是全身性的而非肝脏局部性的。肝切除术后在出现肿瘤复发临床证据之前接受全身化疗的患者比未接受化疗的患者存活时间更长。
