结直肠癌患者发生肝转移后外科治疗的结果分析

目的探讨提高结直肠癌肝转移患者肝切除术后长期生存的方法。方法回顾性总结分析从1981年6月至2005年11月在中国协和医科大学肿瘤医院住院治疗的75例结直肠癌肝转移患者肝切除的结果及临床病理资料。结果75例患者中,男性43例,女性32例,其中原发肿瘤位于结肠39例,原发瘤位于直肠36例,同时性肝转移59例,异时性肝转移16例,45例与原发瘤行同期手术,29例为异时手术,1例原发的直肠癌未手术。并发症发生率为16％（12／75）,手术死亡率为1．33％（1／75）,术后体内仍有肿瘤残留者35例,无残留40例。全组总的1年、3年、5年生存率分别为86．7％,35．5％,22．2％,中位生存时间25个月。体内无肿瘤残留组的1年、3年、5年生存率分别为91．6％,58．1％,34．9％,中位生存时间为38个月,有残留组的1年、3年、5年生存率分别为80．6％,5．4％,5．4％,中位生存时间为18个月,两组在生存时间上经LogRank检验差异显著,P=0．000。结论肝切除能显著延长结直肠癌肝转移的生存期,完整切除所有肝转移及肝外病变的根治性切除是影响预后的重要因素,是提高远期生存率的根本保证。

Outcome of surgical therapy for liver metastasis of colorectal cancer: analysis of 75 cases

OBJECTIVE: To explore the strategy to improve the long term survival of liver metastasis of colorectal cancer after surgical treatment. METHODS: The clinical data of 75 patients with liver metastasis of colorectal cancer, 43 males and 32 females, aged 51.4, who received hepatectomy between January 1981 and November 2005, were analyzed. RESULTS: The primary tumor site was colon in 39 cases, and rectum in 36 cases. Liver metastasis was synchronous in 59 patients, and metachronous in 16 patients. 45 patients received simultaneous liver and colorectal resection, 29 patients received metachronous resection, and 1 patient did not receive primary rectal cancer resection. The operative complication rate and the mortality were 16% (12/75) and 1.33% (1/75) respectively. The overall 1- 3-, and 5-year survival rates were 86.7%, 35.5%, and 22.2% respectively, and the median survival time was 25 months. There were residual tumors in 35 patients. The 1-, 3-, and 5-year survival rates of the residual tumor group were 80.6%, 5.4%, and 5.4% respectively, all significantly lower than those of the radical resection group (91.6%, 58.1%, and 34.9% respectively, and the median survival time of the residual tumor group was 18 months, significantly shorter than that of the radical resection group (38 months) (all P = 0.000). CONCLUSION: Surgical resection of liver metastasis of colorectal cancer significantly prolongs the survival time, and resection of all liver deposits and the extrahepatic disease is the most important factor influencing survival.