Harned R K, Chezmar J L, Nelson R C
Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322.
AJR Am J Roentgenol. 1994 Jul;163(1):93-7. doi: 10.2214/ajr.163.1.8010256.
Despite studies showing increased survival rates for patients after surgical resection of hepatic metastases, recurrences occur in 75% of treated patients. The purpose of this study was to determine the location and time of discovery of recurrent tumor on CT scans after resection of hepatic metastases from colorectal carcinoma.
In a 6-year period, 32 patients (16 men and 16 women) who had undergone partial hepatic resection for colorectal metastases had follow-up CT at our institution. A total of 125 CT examinations of the chest and abdomen were retrospectively reviewed for the presence and location of recurrent disease. Recurrence was either confirmed by biopsy (n = 12) or presumed on the basis of growth of new lesions (n = 17).
With a mean follow-up of 22 months (range, 1-60 months), recurrence was found at 29 sites in 25 patients. Thirteen sites were hepatic, and 16 were extrahepatic. Three patients had both hepatic and pulmonary disease. Recurrence within the liver was away from surgical margins in 11 (85%) of 13 patients at 14 +/- 7 months and adjacent to a surgical margin in the remaining two patients (15%) at 17 +/- 1 months. Extrahepatic recurrences were discovered in the lung in 11 (69%) of 16 patients at 21 +/- 12 months; in an adrenal gland in two patients (13%) at 19 +/- 5 months; in lymph nodes of the porta hepatis in one patient (6%) at 11 months; at the primary colonic anastomosis in one patient (6%) at 3 months; and in a retroperitoneal lymph node in the remaining patient (6%) at 12 months.
Surgery was effective in treating the preoperatively detected hepatic metastases. Only two of 25 patients had recurrence related to a hepatic surgical margin. Most recurrences occur more than 1 year after surgery, most often in lung or liver away from surgical margins, and they probably represent small metastases undetectable with current preoperative or intraoperative techniques.
尽管有研究表明肝转移瘤手术切除后患者生存率有所提高，但75%接受治疗的患者会出现复发。本研究的目的是确定结直肠癌肝转移瘤切除术后CT扫描上复发肿瘤的发现位置和时间。
在6年期间，32例（16例男性和16例女性）因结直肠癌转移接受部分肝切除的患者在我院接受了随访CT检查。对总共125次胸部和腹部CT检查进行回顾性分析，以确定复发病灶的存在和位置。复发通过活检确诊（n = 12）或根据新病灶生长推定（n = 17）。
平均随访22个月（范围1 - 60个月），25例患者的29个部位发现复发。13个部位在肝脏，16个部位在肝外。3例患者同时有肝和肺疾病。肝脏内复发在13例患者中的11例（85%）于14±7个月时出现在远离手术切缘处，其余2例患者（15%）于17±1个月时出现在邻近手术切缘处。肝外复发在16例患者中的11例（69%）于21±12个月时出现在肺部；2例患者（13%）于19±5个月时出现在肾上腺；1例患者（6%）于11个月时出现在肝门淋巴结；1例患者（6%）于3个月时出现在原结肠吻合口；其余1例患者（6%）于12个月时出现在腹膜后淋巴结。
手术对治疗术前检测到的肝转移有效。25例患者中只有2例复发与肝脏手术切缘有关。大多数复发发生在术后1年以上，最常见于远离手术切缘的肺或肝脏，可能代表目前术前或术中技术无法检测到的小转移灶。
