Stief C G, Jáhne J, Hagemann J H, Kuczyk M, Jonas U
Department of Urology, Medizinische Hochschule, Hannover, Germany.
J Urol. 1997 Aug;158(2):375-7.
The postoperative outcome and survival of patients undergoing surgery for metachronous solitary liver metastases of renal cell carcinoma were evaluated.
Between 1983 and 1993, 17 patients with metachronous liver metastases of renal cell carcinoma underwent laparotomy for metastatic liver disease. All patients had undergone radical nephrectomy a mean of 3.6 years before the diagnosis of liver metastases.
Surgical resection was feasible in 13 of 17 patients with right hemihepatectomy in 9 (3 multivisceral resections), wedge resection in 4 and ex situ (mobilization and eversion out of the abdomen) resection in 1. Stage R0 resection (complete removal, negative surgical margins with no macroscopic disease left behind) was possible in 11 of 13 cases (85%). In patients with metastatic liver tissue resection the mortality rate was 31% (4 of 13) with additional significant morbidity in another 2. Mean survival of patients with nonresectable disease was 4 months, which increased to 16 months after resection.
Complete resection of metachronous liver metastases can be achieved in the majority of patients. However, significant morbidity and mortality as well as the limited prognosis even after R0 resection strongly suggest careful patient selection.
评估接受手术治疗肾细胞癌异时性孤立性肝转移患者的术后结局和生存率。
1983年至1993年间，17例肾细胞癌异时性肝转移患者因转移性肝病接受了剖腹手术。所有患者在诊断肝转移前平均3.6年已接受根治性肾切除术。
17例患者中有13例可行手术切除，其中9例行右半肝切除术（3例为多脏器切除术），4例行楔形切除术，1例行体外（移出腹腔并外翻）切除术。13例中有11例（85%）可行R0期切除（完整切除，手术切缘阴性，无肉眼可见病灶残留）。肝转移组织切除患者的死亡率为31%（13例中的4例），另有2例出现严重并发症。不可切除疾病患者的平均生存期为4个月，切除后增至16个月。
大多数患者可实现异时性肝转移的完整切除。然而，严重的发病率和死亡率以及即使R0切除后预后有限，强烈提示需谨慎选择患者。
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