Ohlsson B, Stenram U, Tranberg K G
Department of Surgery, University of Lund, Sweden.
World J Surg. 1998 Mar;22(3):268-76; discussion 276-7. doi: 10.1007/s002689900381.
The aim of this retrospective study was to analyze survival and prognostic factors in 111 consecutive patients undergoing curative resection of liver metastases from colorectal cancer. In addition, the time periods 1971-1984 and 1985-1995 were compared; criteria for first liver resection did not change with time, whereas the attitude toward re-resection was more aggressive during the latter period. Operative mortality was 6% during 1971-1984 and 0% during 1985-1995 (3.6% for all patients). The crude 5-year actuarial survivals were 19% and 35% for patients operated during 1971-1984 and 1985-1995, respectively (25% for the whole period). Relapse at any site was observed in 52 patients (81%) operated during the first period and in 29 patients (67%) operated during the second period; re-resection was performed in 12 (23%) and 15 (52%) of these patients, respectively. Five-year survival after hepatic re-resection was 29% (no operative mortality). In the univariate analysis, significant determinants for long-term survival were, in descending order, a clear resection margin, high degree of fibrosis around the tumor, absence of extrahepatic metastases (including metastases to the liver hilum), use of an ultrasound dissector, low preoperative serum carcinoembryonic antigen (CEA) level, year of resection (1985-1995), and low/moderate grade of liver tumor. There were no 5-year survivors when extrahepatic metastases were present, the liver tumor(s) had a low differentiation or satellites, or the resection margin was involved with tumor. In the multivariate analysis, the determinants were grade of liver tumor, absence of extrahepatic tumor, few intraoperative blood transfusions, low preoperative serum CEA level, and year of resection (1985-1995). It is concluded that: (1) an increased rate of hepatic re-resection was partly responsible for the improved outcome after liver resection for colorectal metastases during recent years; (2) patients with extrahepatic metastases did not benefit from liver resection; and (3) surgery should be performed with a clear resection margin and minimal blood loss.
本回顾性研究旨在分析111例接受结直肠癌肝转移根治性切除术的连续患者的生存情况及预后因素。此外，还对1971 - 1984年和1985 - 1995年这两个时间段进行了比较；首次肝切除的标准未随时间变化，而在后一时期对再次切除的态度更为积极。1971 - 1984年手术死亡率为6%，1985 - 1995年为0%（所有患者为3.6%）。1971 - 1984年和1985 - 1995年接受手术的患者5年粗精算生存率分别为19%和35%（整个时期为25%）。第一时期接受手术的52例患者（81%）和第二时期接受手术的29例患者（67%）出现了任何部位的复发；这些患者中分别有12例（23%）和15例（52%）接受了再次切除。肝再次切除后的5年生存率为29%（无手术死亡）。在单因素分析中，长期生存的重要决定因素按降序排列为切缘清晰、肿瘤周围纤维化程度高、无肝外转移（包括肝门转移）、使用超声解剖器、术前血清癌胚抗原（CEA）水平低、切除年份（1985 - 1995年）以及肝肿瘤低/中度分级。当存在肝外转移、肝肿瘤分化低或有卫星灶或切缘有肿瘤累及情况时，无5年生存者。在多因素分析中，决定因素为肝肿瘤分级、无肝外肿瘤、术中输血少、术前血清CEA水平低以及切除年份（1985 - 1995年）。得出以下结论：（1）近年来肝再次切除率的提高部分是结直肠癌转移肝切除术后结果改善的原因；（2）肝外转移患者不能从肝切除中获益；（3）手术应在切缘清晰且失血最少的情况下进行。
