Fortner J G, Silva J S, Golbey R B, Cox E B, Maclean B J
Ann Surg. 1984 Mar;199(3):306-16. doi: 10.1097/00000658-198403000-00010.
In the United States, there are an estimated 5000 to 6000 new patients annually who might be candidates for major hepatic resection to treat their recurrent colon cancer. Since 1971, the program reported here has evaluated various factors that might influence the curative potential of such an approach. Sixty-five patients had a major hepatic resection from March 1971 through May 1982. Using a stepwise proportional hazard analysis, all data that had been stored in CLINFO (a data analysis system by Bolt, Beranek and Newman; Boston, MA) were evaluated for the effect of multiple variables on the survival of patients with resected hepatic metastases. Twenty-seven had a right hepatic lobectomy; 14 had extended right hepatectomy with one having the caudate lobe also removed; ten had left lobectomy, nine had left lateral segmentectomy; and five had a major hepatic resection with three-dimensional wedge excision of a metastatic deposit in the contralateral lobe. The 30-day operative mortality rate was 7% (4/58) for patients undergoing the standard major hepatic resection. It was 14% for seven patients in whom the isolation-hypothermic perfusion technique was used early in the series. In ten patients, wedge excision only was required to remove the tumor. Stage I disease is defined as tumor confined to the resected portion of the liver without invasion of major intrahepatic vessels or bile ducts. Stage II disease is regional spread and Stage III disease is metastasis to lymph nodes or extraregional sites. The 3-year survival estimate was 66% for the 37 patients with Stage I disease. The 3-year survival estimate for 13 patients with Stage II disease was 58%. Five of the nine patients with Stage III disease are presently alive from 3 to 23 months; one of the other four died at 35 months of disease. The stage of liver disease was the most significant variable in this survival analysis (p = 0.02); Dukes' classification of colorectal primary was significant at p less than 0.05. Those factors found not to be significant determinants of survival were: number of metastatic hepatic deposits, site of colon primary, age, sex, preoperative liver function tests, and CEA.
在美国，估计每年有5000至6000名新患者可能适合进行肝大部切除术以治疗复发性结肠癌。自1971年以来，本文所报告的项目评估了可能影响这种治疗方法治愈潜力的各种因素。1971年3月至1982年5月期间，65例患者接受了肝大部切除术。使用逐步比例风险分析，对存储在CLINFO（Bolt、Beranek和Newman公司的数据分析系统，马萨诸塞州波士顿）中的所有数据进行评估，以确定多个变量对肝转移瘤切除患者生存的影响。27例行右肝叶切除术；14例行扩大右肝切除术，其中1例还切除了尾状叶；10例行左肝叶切除术，9例行左外侧段切除术；5例行肝大部切除术，对侧叶转移瘤行三维楔形切除。接受标准肝大部切除术的患者30天手术死亡率为7%（4/58）。在该系列早期使用隔离低温灌注技术的7例患者中，手术死亡率为14%。10例患者仅需楔形切除肿瘤即可切除肿瘤。I期疾病定义为肿瘤局限于肝脏切除部分，未侵犯主要肝内血管或胆管。II期疾病为区域扩散，III期疾病为转移至淋巴结或区域外部位。37例I期疾病患者的3年生存率估计为66%。13例II期疾病患者的3年生存率估计为58%。9例III期疾病患者中有5例目前存活3至23个月；另外4例中有1例在疾病35个月时死亡。在该生存分析中，肝脏疾病分期是最显著的变量（p = 0.02）；结直肠癌原发灶的Dukes分期在p小于0.05时具有显著性。那些被发现不是生存显著决定因素的因素包括：肝转移灶数量、结肠原发灶部位、年龄、性别、术前肝功能检查以及癌胚抗原（CEA）。
