Yeh K A, Fortunato L, Hoffman J P, Eisenberg B L
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
Am Surg. 1997 Jan;63(1):63-8.
Surgical resection remains the only curative therapy for hepatic metastases from colon and rectal carcinoma. Many patients will be unresectable or have close microscopic margins. Cryoablation may improve local control and survival in those cases. From February 1992 to May 1995, patients with metastatic colon and rectal carcinoma who underwent cryoablation of surgical margins following hepatic resection or cryoablation of hepatic metastases were reviewed with attention to patient and tumor characteristics, clinical course, local control, and survival. Twenty-four patients (10 female, 14 male) with a mean age of 63 years (range, 34-84 years) underwent cryosurgical ablation for hepatic metastases. Twelve were for central lesions and 12 for gross or microscopically positive resection margins. Surgery was performed with curative intent for 21 and for palliation in 3 patients. The mean hospital stay was 8.4 days (range, 5-15 days). Complications included three cases of parenchymal cracking and a single bile leak. Two of 14 patients who developed pleural effusions required treatment. Perioperative mortality was 8.3 per cent (2 of 24): one myocardial infarction and one cerebrovascular accident. Four of 21 treated for cure had hepatic recurrence, and six had only extrahepatic recurrence. Median time to recurrence was 9.5 months. With median follow-up of 19 months, mean actuarial disease-free (DFS) and overall survival (OS) rates are as follows. Those with central lesions (n = 12) had a mean OS rate of 31 months and a mean DFS rate of 23 months. Those with close resection margins (n = 12) had a mean OS rate of 31 months and a median DFS rate of 19.5 months. Total patients (n = 24) had a mean OS rate of 32.7 months and a mean DFS rate of 23.5 months. We conclude that cryoablation of unresectable hepatic metastases or close resection margins is safe and may allow for improved survival in selected patients with metastatic colon and rectal carcinoma.
手术切除仍然是治疗结肠和直肠癌肝转移的唯一治愈性疗法。许多患者将无法进行手术切除或手术切缘接近显微镜下切缘。在这些情况下，冷冻消融可能会改善局部控制并提高生存率。从1992年2月至1995年5月，对接受肝切除术后手术切缘冷冻消融或肝转移瘤冷冻消融的转移性结肠癌和直肠癌患者进行了回顾，重点关注患者和肿瘤特征、临床病程、局部控制和生存率。24例患者（10例女性，14例男性），平均年龄63岁（范围34 - 84岁）接受了肝转移瘤的冷冻手术消融。12例为中央型病变，12例为大体或显微镜下切缘阳性。21例手术目的为治愈，3例为姑息治疗。平均住院时间为8.4天（范围5 - 15天）。并发症包括3例实质破裂和1例胆漏。14例出现胸腔积液的患者中有2例需要治疗。围手术期死亡率为8.3%（24例中的2例）：1例心肌梗死和1例脑血管意外。21例接受根治性治疗的患者中有4例出现肝复发，6例仅出现肝外复发。复发的中位时间为9.5个月。中位随访19个月，平均精算无病生存率（DFS）和总生存率（OS）如下。中央型病变患者（n = 12）的平均OS率为31个月，平均DFS率为23个月。切缘接近的患者（n = 12）的平均OS率为31个月，中位DFS率为19.5个月。全部患者（n = 24）的平均OS率为32.7个月，平均DFS率为23.5个月。我们得出结论，对无法切除的肝转移瘤或切缘接近的情况进行冷冻消融是安全的，并且可能会提高部分转移性结肠癌和直肠癌患者的生存率。
