Cady B, Jenkins R L, Steele G D, Lewis W D, Stone M D, McDermott W V, Jessup J M, Bothe A, Lalor P, Lovett E J, Lavin P, Linehan D C
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Ann Surg. 1998 Apr;227(4):566-71. doi: 10.1097/00000658-199804000-00019.
To update the analysis of technical and biologic factors related to hepatic resection for colorectal metastasis in a large single-institution series to identify important prognostic indicators and patterns of failure.
Surgical therapy for colorectal carcinoma metastatic to the liver is the only potentially curable treatment. Careful patient selection of those with resectable liver-only metastatic disease is crucial to the success of surgical therapy.
Two hundred forty-four consecutive patients undergoing curative hepatic resection for metastatic colorectal carcinoma were analyzed retrospectively. Variables examined included sex, stage of primary lesion, size of liver lesion(s), number of lesions, disease-free interval, ploidy, differentiation, preoperative carcinoembryonic antigen level, and operative factors such as resection margin, use of cryotherapy, intraoperative ultrasound, and blood loss.
Surgical margin, number of lesions, and carcinoembryonic antigen (CEA) levels significantly control prognosis. Patients with only one or two liver lesions, a 1-cm surgical margin, and low CEA levels have a 5-year disease-free survival rate of more than 30%. Disease-free interval, original stage, bilobar involvement, size of metastasis, differentiation, and ploidy were not significant predictors of recurrence. The pattern of failure correlates with surgical margin. Routine use of intraoperative ultrasound resulted in an increased incidence of negative surgical margin during the period examined.
Surgical resection or cryotherapy of hepatic metastasis from colorectal cancer is safe and curable in appropriately selected patients. Biologic factors, such as number of lesions and carcinoembryonic antigen levels, determine potential curability, and surgical margin governs the patterns of failure and outcome in potentially curable patients. Optimization of selection criteria and surgical resection margins will improve outcome.
在一个大型单机构系列研究中更新对与结直肠癌肝转移肝切除相关的技术和生物学因素的分析，以确定重要的预后指标和失败模式。
结直肠癌肝转移的手术治疗是唯一可能治愈的治疗方法。仔细选择仅可切除肝转移病灶的患者对于手术治疗的成功至关重要。
回顾性分析244例接受结直肠癌肝转移根治性肝切除的连续患者。检查的变量包括性别、原发灶分期、肝病灶大小、病灶数量、无病间期、倍体、分化程度、术前癌胚抗原水平以及手术因素，如切缘、冷冻治疗的使用、术中超声和失血量。
手术切缘、病灶数量和癌胚抗原（CEA）水平显著影响预后。仅有一两个肝病灶、手术切缘为1 cm且CEA水平低的患者5年无病生存率超过30%。无病间期、原发分期、双叶受累、转移灶大小、分化程度和倍体不是复发的显著预测因素。失败模式与手术切缘相关。在所研究期间，常规使用术中超声导致阴性手术切缘的发生率增加。
对于适当选择的患者，结直肠癌肝转移的手术切除或冷冻治疗是安全且可治愈的。生物学因素，如病灶数量和癌胚抗原水平，决定了潜在的可治愈性，而手术切缘则决定了潜在可治愈患者的失败模式和结局。优化选择标准和手术切缘将改善结局。
