Zavadsky K E, Lee Y T
General Surgery Service, Tripler Army Medical Center, Honolulu, Hawaii.
Am Surg. 1994 Dec;60(12):929-33.
We studied 328 cases of colorectal carcinoma (stages I-IV) seen at our hospital during a 19-year period. We found that 15% of these had liver metastasis (LM) at initial diagnosis, and 14% developed LM after resection of their primary cancers. Among the 73 patients with LM, the lesion was confined to the liver (LM only) in 40 patients. Using our criteria of "resectability" of LM, 45% with LM only had resectable LM lesions, but only 15% (six patients) actually had hepatic resections. We had no operative death nor major complication. Five of the six patients with LM resected lived 3 years or longer, but none of the other 34 patients with LM only (either non-resectable or resectable but not operated on) lived more than 35 months. Although our series is relatively small, our data are consistent with results coming from other national and institutional studies. The controversies and issues relating to resection of colorectal liver metastasis are discussed.
我们研究了我院在19年期间收治的328例结直肠癌患者(I-IV期)。我们发现,其中15%在初诊时已有肝转移(LM),14%在原发癌切除后发生肝转移。在73例有肝转移的患者中,40例病变局限于肝脏(仅肝转移)。根据我们制定的肝转移“可切除性”标准,仅肝转移患者中有45%的肝转移灶可切除,但实际接受肝切除术的仅占15%(6例患者)。我们没有手术死亡病例,也没有出现严重并发症。6例接受肝转移灶切除的患者中有5例存活了3年或更长时间,但其他34例仅肝转移患者(不可切除或可切除但未手术)无一人存活超过35个月。尽管我们的病例系列相对较小,但我们的数据与其他国家和机构的研究结果一致。本文还讨论了结直肠癌肝转移切除术相关的争议和问题。