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[原发性和继发性肝癌肝内复发病灶的切除术]

[Resections of recurrence in the liver of primary and secondary liver cancers].

作者信息

Herfarth C, Heuschen U A, Lamade W, Lehnert T, Otto G

机构信息

Chirurgische Klinik und Poliklinik, Universität Heidelberg.

出版信息

Chirurg. 1995 Oct;66(10):949-58.

PMID:8529447
Abstract
  1. Only one third of primary hepatic carcinomas and in particular hepatocellular carcinomas are amenable to liver resection. Approximately half of these patients develop tumor recurrences within the first two years accounting for the poor prognosis of this condition. The liver is the site of first failure in about 80 percent of patients. Secondary liver surgery for intrahepatic recurrence is technically possible in about one third of the patients at low operative mortality (< 5 percent). Long-term prognosis following potentially curative liver reresection for hepatosellular carwinoma compares favourably (5-year survival approximately 50 percent) with the prognosis after resection of the primary tumor. For potentially curative treatment liver transplantation is the only alternative to hepatic reresection, while alcohol injection and chemoembolization are merely palliative procedures. II) Liver resection represents the only potentially curative form of treatment for hepatic metastases from collorectal cancer. Operative mortality is generally less than 5 percent and 5-year survival of 20-40 percent can be expected. Secondary hepatic recurrences following hepatic resection of colorectal metastases are amenable to reresection in approximately 10 percent of patients. Selection criteria for reresection are the same as for primary liver reresection. Median survival following secondary liver resection is 32 months and this is identical to the median survival after the first liver resection for colorectal metastases.
摘要
  1. 原发性肝癌,尤其是肝细胞癌,只有三分之一适合肝切除。这些患者中约有一半在头两年内出现肿瘤复发,这导致了该疾病的预后较差。在约80%的患者中,肝脏是首次出现功能衰竭的部位。肝内复发的二次肝手术在约三分之一的患者中技术上可行,手术死亡率较低(<5%)。肝细胞癌潜在根治性肝切除后的长期预后与原发性肿瘤切除后的预后相比具有优势(5年生存率约为50%)。对于潜在根治性治疗,肝移植是肝切除的唯一替代方法,而酒精注射和化疗栓塞仅仅是姑息性治疗手段。II) 肝切除是结直肠癌肝转移唯一可能的根治性治疗方式。手术死亡率一般低于5%,预计5年生存率为20%-40%。结直肠癌肝转移肝切除术后的肝内复发在约10%的患者中适合再次切除。再次切除的选择标准与原发性肝切除相同。二次肝切除后的中位生存期为32个月,这与首次结直肠癌肝转移肝切除后的中位生存期相同。

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