Robinson B J, Rice T W, Strong S A, Rybicki L A, Blackstone E H
Departments of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
J Thorac Cardiovasc Surg. 1999 Jan;117(1):66-75; discussion 75-6. doi: 10.1016/s0022-5223(99)70470-8.
Conventional management of stage IV colorectal carcinoma is palliative. The value of resecting both liver and lung colorectal metastases that occur in isolation of other sites of metastasis is undetermined.
Our objectives were to (1) assess the efficacy of resecting both hepatic and pulmonary metastases, (2) investigate the influence of the sequence and timing of metastases, and (3) identify the profile of patients likely to benefit from both hepatic and pulmonary metastasectomy.
Of 48 patients identified with resection of colorectal cancer and, at some point in time, both liver and lung metastases, 25 patients underwent metastasectomy (resection group). The remaining 23 patients comprised the nonresection group. Risk factors for death were identified by multivariable analyses.
Median survival was longer after the last metastatic appearance in the resection group (16 months) than in the nonresection group (6 months; P <.001). The pattern of risk also differed; it peaked at 2 years and then declined in the resection group but was constant in the nonresection group. In the resection group, patients with metachronous resections survived longer after colorectal resection (median, 70 months) than patients with synchronous (median, 22 months) or mixed resections (median, 31 months; P <.001). Risk factors for death included older age, multiple liver metastases, and a short disease-free interval.
Younger patients with solitary metachronous metastases to the liver, then the lung, and long disease-free intervals are more likely to benefit from resection of both liver and lung metastases. Patients with risk factors also had better survival with resection than without resection.
IV期结直肠癌的传统治疗是姑息性的。孤立于其他转移部位出现的肝肺结直肠癌转移灶同时切除的价值尚未确定。
我们的目的是（1）评估肝肺转移灶同时切除的疗效，（2）研究转移灶的顺序和时间的影响，以及（3）确定可能从肝肺转移灶切除术获益的患者特征。
在48例确诊为结直肠癌且在某个时间点同时出现肝肺转移的患者中，25例患者接受了转移灶切除术（切除组）。其余23例患者组成非切除组。通过多变量分析确定死亡的危险因素。
切除组最后一次出现转移后的中位生存期（16个月）长于非切除组（6个月；P<.001）。风险模式也有所不同；在切除组中，风险在2年时达到峰值，然后下降，但在非切除组中保持不变。在切除组中，异时性切除的患者在结直肠癌切除术后的生存期（中位生存期70个月）长于同时性切除（中位生存期22个月）或混合性切除（中位生存期31个月）的患者（P<.001）。死亡的危险因素包括年龄较大、多发肝转移和无病间期短。
较年轻、肝转移灶为孤立性异时性、随后出现肺转移且无病间期长的患者更有可能从肝肺转移灶切除术中获益。有危险因素的患者接受切除后的生存期也比未接受切除的患者更好。
