Seifert J K, Staupendahl D, Junginger T
Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg-Universität Mainz.
Chirurg. 1997 Mar;68(3):247-54. doi: 10.1007/s001040050182.
Between 1985 and 1994, 262 patients with metastases underwent resectional treatment in the Department for General and Abdominal Surgery of the University of Mainz. Twenty-seven patients with recurrent metastases were treated with repeat resections. The records of these 27 patients were reviewed and analyzed. After 42 repeat resections, 4 of 27 patients (14.8%) developed complications. Three of 27 patients died in the postoperative period (11.1%). For patients with R0 resection of metastases from colorectal primaries the median survival time was 69 months after resection of the primary tumor (n = 16), 38 months after the first resection of metastases (n = 15), and 25 months after the second resection of metastases (n = 15). After the last repeat resection of metastases in each patient, median survival was 25 months in patients with R0 resection (n = 11), compared to 7 months following R1/2 resection (n = 5) (P = 0.007). Disease-free survival following first R0 resection of colorectal metastases (n = 15), was not significantly different from disease-free survival following repeated R0 resection of colorectal metastases (n = 21). Patients with repeat resection of colorectal liver metastases (n = 9) had longer disease-free survival (median 18 months) than patients with repeat resection of colorectal metastases in organs other than liver or lungs (median 4 months; n = 4) (P = 0.005). Repeat resections for metastases are characterized by low operative risk and a prognostic benefit for highly selected patients.
1985年至1994年间，262例有转移灶的患者在美因茨大学普通及腹部外科接受了切除治疗。27例复发转移患者接受了再次切除治疗。对这27例患者的记录进行了回顾和分析。在42次再次切除后，27例患者中有4例（14.8%）出现并发症。27例患者中有3例在术后死亡（11.1%）。对于结直肠癌原发灶转移灶R0切除的患者，原发肿瘤切除后的中位生存时间为69个月（n = 16），首次转移灶切除后的中位生存时间为38个月（n = 15），第二次转移灶切除后的中位生存时间为25个月（n = 15）。在每位患者最后一次转移灶再次切除后，R0切除患者的中位生存时间为25个月（n = 11），而R1/2切除患者为7个月（n = 5）（P = 0.007）。结直肠癌转移灶首次R0切除后的无病生存期（n = 15）与结直肠癌转移灶重复R0切除后的无病生存期无显著差异。结直肠癌肝转移灶重复切除的患者（n = 9）的无病生存期（中位18个月）比肝或肺以外器官的结直肠癌转移灶重复切除的患者（中位4个月；n = 4）更长（P = 0.005）。转移灶的再次切除具有低手术风险，且对经过严格挑选的患者有预后益处。
