胃肠道癌局限性肝转移的95例治疗分析

目的探讨胃肠道癌局限性肝转移患者的治疗方法.方法对我院1987-2000年收治的原发癌根治术后的95例胃肠道癌局限性肝转移患者进行回顾性研究.结果原发癌加肝转移灶切除的患者1、3、5年生存率分别为76.1%、39.1%、19.4%,而肝转移灶未治疗的患者其分别为26.7%、0、0,1、3年生存率的差异均有显著性(P＜0.05);肝转移灶微波固化和无水酒精注射及肝脏区域化疗的合并组患者1、3、5年生存率分别为73.5%、29.4%、12.0%,其与肝转移灶切除组的差异均无显著性(P＞0.05).与肝转移灶未治疗组的1年生存率差异有显著(P＜0.05).结论胃肠道癌局限性肝转移患者,应尽可能彻底切除原发癌和肝转移灶,肝转移灶微波固化和无水酒精注射及肝脏区域化疗是其治疗的重要的补充.     

大肠癌伴肝转移患者的预后因素

目的探讨影响大肠癌伴肝转移患者预后的因素.方法1995年5月-1999年12月间本院外科手术治疗的64例大肠癌伴肝转移患者,部分患者全身化疗或肝动脉插管化疗,并对其临床资料进行统计分析.结果本组大肠癌肝转移患者占大肠癌患者10.2%.肝转移灶大小、术前CEA水平、原发灶切除、辅助治疗方式为影响生存的独立的预后因素.年龄、性别、肿瘤部位、分化程度、肝转移灶数目与预后无关.肝转移灶＞5cm、术前CEA＞100μg/ml、原发灶未切除的患者的生存时间(3.52月)显著低于其他患者(21.60月).结论治疗方式对肠癌肝转移患者预后影响显著,应积极切除原发灶、治疗转移灶.肝动脉插管化疗优于全身化疗.肝转移灶大小、术前CEA水平是重要的预后指标.     

大肠癌肝转移的治疗体会（附28例报告）

自1989年－1995年共收治28例大肠癌肝转移的病人，在大肠癌根治的基础上，采用各种方法治疗肝转移癌，取一定疗效，其中行肝叶切除4例，肝动脉结扎置管化疗和门静脉属支置管化疗10例，放射介入肝动脉栓塞化疗8例，B超引导下无水酒精注射5例，全身化疗加免疫治疗1例，均不同程度革延长了生存期。大肠癌发生肝转移癌的发生率较高，如能早期发现并予以切除，可获得较好的疗效，影响手术切除的因素有（1）手术的时机；（2）肝脏切除量；（3）适宜的手术指征。肝切除以外的其它治疗方法如全身化疗加免疫疗法，对于不能手术的弥散型肝转移癌仍不失为较好的治疗方法。     

结直肠癌局限性肝转移的治疗

[目的]探讨结直肠癌局限性肝转移多种治疗方法的价值。[方法]对我院1987年-2000年收治的原发癌根治术后的引例结直肠癌局限性肝转移患者进行回顾性研究。[结果]原发癌加肝转移灶切除患者1、3、5年生存率分别为85.7％、46.9％、32.1％,而肝转移灶未治疗的患者分别为26.7％、0、0,两者的差异均有显著性（P<0.05）;肝转移灶微波固化和无水酒精注射及肝脏区域化疗合并组患者1、3、5年生存率分别为 74.2％、42.9％、19.2％,其与肝转移灶切除组的差异均无显著性（P>0.05）,与肝转移灶未治疗组的1、3年生存率差异有显著性（P<0.05）。[结论]1结直肠癌局限性肝转移患者,应尽可能彻底切除原发癌和肝转移灶,肝转移灶微波固化和无水酒精注射及肝脏区域化疗是其治疗的重要补充。     

胃和结直肠癌同时伴有肝转移的外科治疗——附48例分析

 本文报导了48例胃和结直肠癌同时伴有肝转移的外科治疗,其中根治性肝切除18例,1、3、5年生存率分别为77.8%、44.4%、33.3%。姑息切除8例,1、3、5年的生存率为37.5%、25%、12.5%。对无法行肝切除,而分别作了单纯肝动脉结扎及肝动脉插管各4例,均在6个月内死亡。肝动脉结扎加插管化疗8例,平均生存期为10.4个月,瘤内无水酒精注射6例,平均生存期为15个月。作者认为转移性肝癌肝切除是目前首选的治疗方式。对无法切除的肝癌采用肝动脉,门静脉双插管化疗和瘤内无水酒精注射等综合治疗,无疑将会提高疗效。     

大肠癌肝转移86例外科综合治疗

 目的 探讨大肠癌肝转移外科综合治疗的方法及临床效果。方法 对86例大肠癌肝转移患者均在行大肠癌根治术的同时，分别配合部分肝切除、全身静脉化疗、介入化疗、无水酒精注射、腹腔化疗泵植入等方法进行治疗。结果 本组74例原发癌位于左半或右半结肠，12例原发癌位于直肠，肝转移灶发生在左半结肠者明显多于右半结肠者，两组差异有极显著性（P＜0.01）；在综合治疗中，以左、右半结肠癌根治性切除（R2-R3）+肝转移癌部分肝切除术+静脉化疗组疗效较佳，其3年生存率明显高于其他组，差异有极显著性（P＜0.01）。而各组间五年生存率无显著差异（P＜0.05）。结论 大肠癌肝转移患者，视肝转移灶在肝内的部位，大小，多少进行合理的综合治疗，能提高病人的生存质量和生存期。     

大肠癌肝转移的治疗

目的 探讨大肠癌肝转移治疗的有效方法.方法 对大肠癌肝转移86例,在原发灶切除的基础上,分为转移灶单纯切除、栓塞化疗切除、单纯栓塞化疗和全身化疗四组进行治疗,并分析单发性肝转移癌、局限于一段或一叶的多发性转移癌、左右肝均有转移癌的不同疗效.结果 单纯切除组和栓塞化疗切除组的一年生存率,均优于单纯栓塞化疗组(P<0.05);而单纯栓塞化疗组的一年生存率又优于单纯化疗组(P<0.05).在手术切除的两组病例中,单发性转移癌术后一年生存率优于左右肝均有转移灶的术后生存率(P<0.01);而局限于肝脏一段或一叶的多发性转移癌,栓塞化疗切除组的三年生存率,优于单纯切除组(P相似文献   

大肠癌肝转移27例诊治体会

目的　对大肠癌肝转移的治疗进行总结。方法　 1980～ 2 0 0 0年收治大肠癌肝转移 2 7例 ,就其治疗进行总结分析。结果　本组 2 7例治疗方法为无水酒精瘤内注射 4例 ,根治性切除术 11例 ,非根治性切除术 6例 ,未进行治疗 6例。本组资料表明治疗组明显优于非治疗组 ,根治性切除明显优于非根治性切除术。结论　对大肠癌肝转移应争取肝转移灶切除术 ,力争根治性切除术 ,如不能切除的应进行综合治疗     

大肠癌肝转移27例诊治体会

目的 对大肠癌肝转移的治疗进行总结。方法 1980～2000年收治大肠癌肝转移27例，就其治疗进行总结分析。结果 本组27例治疗方法对无水酒精瘤内注射4例，根治性切除术11例，非根治性切除术6例，未进行治疗6例，本组资料表明治疗组明显优于非治疗组，根治性切除明显优于非根治性切除术。结论 对大肠癌肝转移应争取肝转移灶切除术，力争根治性切除术，如不能切除的应进行综合治疗。     

大肠癌伴肝移植的治疗（除77例分析）

目的　探讨大肠癌伴肝转移 ,不同治疗方法的效果。方法　分析我院自 1994年 1月～ 1999年 12月共 77例大肠癌伴肝转移病人的资料。结果　原发灶与肝转移灶同时切除十化疗者的效果、生存率明显好于其它未行肿瘤切除的其它方案 ,其 1、2、3、5年的生存率分别为 :91.6 7% (2 2 /2 4)、6 2 .5 0 % (15 /2 4)、41.6 7% (10 /2 4)、2 9.7% (7/2 4)。其它方案仅有少数患者存活过一年。结论　对于大肠癌伴肝转移的治疗应持积极的态度 ,部分患者可获得良好的预后。     

Management of the Hepatic Lymph Nodes During Resection of Liver Metastases from Colorectal Cancer: A Systematic Review

The aim of this review is to assess the role of hepatic lymphadenectomy in patients undergoing liver resection for colorectal metastases. Meta-analysis of trials identified by a systematic literature search of the Medline, Embase and Central databases was performed. There were no randomized controlled trials which assessed the survival benefit to patients undergoing liver resection for colorectal metastases of either a routine or a ‘selective’ lymphadenectomy. The prevalence of nodal metastases after lymphadenectomy was 8.4 %. The overall 3-year and 5-year survival rates in patients with hepatic lymph node metastases undergoing hepatectomy were 21.8 % (63 of 288 patients) and 8.5 % (27 of 315 patients), respectively, compared with 58.2 % (1,366 of 2,346 patients) and 47.5 % (1,717 of 3,609 patients) in patients undergoing hepatectomy who had no hepatic nodal metastases. The odds ratios for 3-year and 5-year mortality in node positive disease compared with node negative disease were 4.54 (95 % confidence interval 3.15–6.54) and 6.33 (95 % confidence interval 4.28–9.36), respectively. In conclusion, long-term survival rates are low in patients undergoing hepatectomy with hepatic lymph node metastases. The poor outcome is irrespective of whether the nodal metastases are discovered following routine lymphadenectomy or are detected because of pathological enlargement. Further trials in this patient group are required.     

Debulking treatment with CT-guided percutaneous radiofrequency ablation and hepatic artery infusion of floxuridine improves survival of patients with unresectable pulmonary and hepatic metastases of colorectal cancer

The survival of most patients with both unresectable hepatic and pulmonary metastases of colorectal cancer is poor. In this retrospective study, we investigated the efficacy of computed tomography （CT）-guided radiofrequency ablation （RFA） and systemic chemotherapy plus hepatic artery infusion of floxuridine （HAI-FUDR）. Sixty-one patients were selected from 1,136 patients with pulmonary and hepatic metastases from colorectal cancer. Patients were treated with RFA and systemic chemotherapy plus HAI-FUDR （ablation group, n=39） or systemic chemotherapy plus HAI-FUDR （FUDR group, n=22）. Patients in the two groups were matched by sex, age, number of metastases, and calendar year of RFA or FUDR. Survival data were evaluated by using univariate and multivariate analyses. Clinical characteristics were comparable between the two groups. Al patients in the ablation group underwent RFA and chemotherapy. Median fol ow-up was 56.8 months. The 1-, 3-, and 5-year overall survival （OS） rates were 97%, 64%, and 37%, respectively, for the ablation group, and 82%, 32%, and 19%, respectively, for the FUDR group. The 1-, 3-, and 5-year survival rates after metastasis were 97%, 49%, and 26%for the ablation group, and 72%, 24%, and 24%for the FUDR group, respectively. The median OS times were 45 and 25 months for the ablation and FUDR groups, respectively. In the multivariate analysis, treatment al ocation was a favorable independent prognostic factor for OS （P = 0.001） and survival after metastasis （P = 0.009）. These data suggest that the addition of RFA to systemic chemotherapy plus HAI-FUDR improves the survival of patients with both unresectable hepatic and pulmonary metastases from colorectal cancer.     

Resection made possible following hepatic arterial infusion in 2 cases of hepatic metastases from colorectal cancer

Of 66 examples of hepatic metastases from colorectal cancer, 30 cases in which resection was performed had 3- and 5-year cumulative survival rates of 66.7% and 56.8%, while in 36 cases in which resection was not possible, the percentages were 8.7% and 2.9%, respectively. In two of the latter cases, resection was possible following WHF (5-FU 1,000 mg/m2 5 h qw). Case 1: A 58-year-old male, with rectal cancer and multiple metastases (H3, synchronous). Arterial infusion was performed 21 times, with the total volume of 5-FU administered being 31.5 g. The size of the lesions was reduced and hepatic resection was performed. The patient later died due to local recurrence and intra-abdominal lymph node metastases. He had survived 2 years and 11 months following hepatic resection and was free from recurrence of hepatic metastases. Case 2: An 82-year-old female, with cancer of the ascending colon, sigmoidal colon and multiple hepatic metastases (H3, metachronous). Arterial infusion was performed 16 times, with the total amount of 5-FU administered being 20 g. A lowering of CEA levels and reduction of tumor size were achieved, and hepatic resection was performed. Seven months following hepatic resection, CEA levels are normal and no distant metastases or recurrence in the residual liver have been found: possibly a complete cure. Even among cases of unresectable hepatic metastases from colorectal cancer, there are some in which resection is possible following hepatic arterial infusion chemotherapy, with the possibility of complete cure.     

Hepatic cryotherapy and regional chemotherapy with or without resection for liver metastases from colorectal carcinoma: how many are too many?

BACKGROUND: The number of hepatic metastases for which resection or ablation is appropriate remains controversial. METHODS: A retrospective analysis was performed of prospectively collected data from patients with liver metastases from colorectal carcinoma who underwent hepatic cryotherapy and hepatic arterial chemotherapy (HAC) with or without undergoing resection. Patients routinely had preoperative bone scans, chest computed tomography (CT) scans, and abdominal angio-CT scans. Positron emission tomography scans were unavailable. All patients were followed until June 2002 or until death occurred. Kaplan-Meier and Cox regression methods were used to evaluate the impact of 17 potentially prognostic factors on survival. RESULTS: One hundred seventy-two patients who underwent hepatic cryotherapy and HAC with or without undergoing liver resection for in situ eradication of metastases formed the basis of this report. One patient (0.6%) died postoperatively from myocardial infarction. The morbidity rate was 27.9%. The median survival was 28 months (range, 0-98 months). The factors age < or = 50 years, well-differentiated or moderately differentiated primary tumor, small cryolesions (<3.5 cm), complete eradication of extrahepatic metastases at cryotherapy, and low preoperative carcinoembryonic antigen (CEA) levels were associated independently with a favorable outcome. In addition, a univariate analysis showed that the absence of untreated extrahepatic disease at laparotomy, postoperative CEA normalization, and a large decline in CEA levels were significant statistically. The number of lesions was not prognostic. One hundred forty-six patients (84.9%) who underwent a complete operation had 1-year, 2-year, 3-year, 4-year, and 5-year survival rates of 89%, 65%, 41%, 24%, and 19%, respectively. The median survival of patients with 1 metastasis, 2 metastases, 3 metastases, 4 metastases, 5 metastases, 6 or 7 metastases, and 8-12 metastases were 32 months, 29 months, 30 months, 31 months, 27 months, 37 months, and 21 months, respectively (P=0.7859). Twenty-five patients had 6 or 7 lesions, and their 5-year survival rate was 25%. CONCLUSIONS: When all colorectal hepatic lesions were eradicated, the numbers of hepatic metastases were not prognostic of survival in patients with liver metastases from colorectal carcinoma.     

再次肝切除手术对结直肠癌肝转移复发患者的临床疗效和生存情况的影响因素

目的 探讨再次肝切除手术对结直肠癌肝转移复发患者的临床疗效和生存情况的影响因素.方法 回顾性分析94例结直肠癌肝转移复发患者临床相关资料,其中38例行再次肝切除术(观察组),其他56例进行内科化疗(对照组).结果 分别进行再次手术和化疗后,结直肠癌肝转移复发患者的1、3、5年生存率观察组为81.6%、52.6%和31.6%;对照组为62.5%、21.4%、7.1%,观察组患者生存率显著高于对照组(P<0.05).针对结直肠癌肝转移复发患者再次切除术的预后可能影响因素进行分析,其中癌直径大小、复发转移灶个数、切缘情况与患者5年生存率有关(P<0.05).术后并发症发生率为28.9%,均经过对症处理可耐受.结论 对于结直肠癌肝转移复发患者,再次肝切除术能提高远期疗效,对于癌直径较小、复发转移灶个数少、切缘阳性的患者效果更好.     

Microwave coagulation therapy for liver metastases from colorectal cancer

Hepatic resection has gained acceptance as the most effective therapy for liver metastases from colorectal cancer. Microwave coagulation therapy (MCT) and radiofrequency ablation as well as resection are also reported as effective therapies. We analyzed the prognosis of 52 patients with liver metastases from colorectal cancer treated with MCT as the first radical therapy. A total of 4 percutaneous MCT's (3 cases with interruption of hepatic blood flow), 23 MCT's with laparotomy, and 25 with hepatic resection + MCT with laparotomy were performed. Thirty-three MCT's performed as a second therapy for recurrence in the liver were also analyzed. Clinical risk scoring as reported by Fong, et al was used in our cases. The indication for percutaneous MCT with interruption of hepatic blood flow is solitary tumor less than 20 mm in diameter. The 5-year survival rate for the 4 percutaneous MCT's, 23 MCT's with laparotomy, and 25 hepatic resection + MCT's with laparotomy and 68 hepatic resections were 20, 24 and 24%, respectively. No significant difference was found among them. The 5-year survival rate for the 17 MCT's and 12 hepatic resections with recurrence in the liver were 20% and 24%, respectively. There was no significant difference found between them. The 5-year survival rate for the 28 CRS3 was 17%, almost equal to the rate, 20%, reported by Fong, et al for hepatic resections only. MCT is effective therapy for liver metastases from colorectal cancer, recurrence in the liver, and hepatic resections.     

198例结直肠癌肝转移患者外科治疗的疗效分析

背景与目的:肝脏是结直肠癌常见的转移部位,35%的患者在确诊时已发生肝转移,肝转移患者的预后较差。尽管手术切除、化疗、射频消融术、介入治疗等手段应用于临床,但治疗效果不同。本研究探讨结直肠癌肝转移外科治疗的临床疗效。方法:对我院5年间经病理检查证实的198例结直肠癌肝转移患者的临床资料进行回顾性分析。根据治疗方法的不同进行分组:根治性切除组46例(23.2%)、姑息性切除组43例(21.7%)、手术探查组或最佳支持治疗组29例(14.6%)、肝动脉置泵化疗组41例(20.7%),全身化疗组39例(19.7%);对其生存期进行比较和统计学分析。结果:根治性切除组中位生存期37.1个月,5年生存率为31.2%;姑息性切除组的中位生存期14.3个月,5年生存率为0;肝动脉置泵化疗组的中位生存期21.3个月,5年生存期为7.5%;全身性化疗和探查组或最佳支持治疗组的中位生存期分别为18.7个月、6.3个月,均无5年生存者。根治性切除组与其他组比较,中位生存期有统计学意义(P<0.01)。结论:根治性切除是提高结直肠癌肝转移患者生存率的重要手段;姑息性切除治疗效果并不优于辅助性治疗,对于不能根治性切除的病例可采用肝动脉置泵化疗。     

Consideration of surgical treatment for recurrence after the resection of hepatic metastases from colorectal cancer]

We considered treatment for recurrence following the resection of hepatic metastases from colorectal cancer. The subjects of this study were 15 of 29 patients who had undergone WHF arterial infusion following resection of hepatic metastases from colorectal cancer, in whom there was a recurrence. Of these 15 cases, 6 involved recurrence in a single organ (residual liver, 4; lung, 1; local area, 1), 7 involved two organs (residual liver and lung, 2; residual liver and local area, 2; residual liver and bone, 1; spleen and intra-abdominal lymph node, 1; intra-abdominal lymph node and peritoneum, 1) and 2 involved three organs (lung, bone and abdominal wall, 1; lung, peritoneum and distal lymph node, 1). Reresection was performed in all cases in which recurrence occurred in a single organ. For those cases in which recurrence occurred in two or more organs, reresection and infusion were performed in the 4 cases of recurrence in the residual liver and reresection was performed in the case of recurrence in the spleen and intra-abdominal lymph node (No. 16), the case of local recurrence and the case involving the abdominal wall. The 5-year survival rate of the 29 cases who underwent initial hepatic resection was 61.9%. Five years following resection, the recurrence rate in the residual liver was 38.3%. The survival rates following treatment for recurrence were 76.9, 51.3 and 25.6% for 1, 3 and 5 years, respectively. Of the 8 deaths which have occurred to date, only one was directly related to an increase in hepatic metastases. Following resection of hepatic metastases from colorectal cancer, WHF provides a high rate of prevention as well as a high survival rate. Furthermore, with regard to recurrence following WHF treatment, if the recurrence is in only one organ, there is the possibility of achieving effective treatment by reresection (WHF = 5-FU 1,000 mg/m2 5 hrs qw).     

Surgical treatment of liver metastases

Approximately 50% to 60% of patients with colorectal cancer will develop hepatic metastases during the course of their illness, with 20% to 30% of patients having liver metastases at time of diagnosis. In nearly a quarter of these patients the liver is the only site of disease. Surgical resection of isolated hepatic metastases has been associated with a 27% to 37% 5-year survival and confers a survival advantage compared to patients not undergoing resection. Thorough preoperative and intraoperative evaluation is necessary to select appropriate surgical candidates who may benefit from resection. This article examines criteria useful in patient selection, and also reviews the management of recurrent hepatic metastases and the role of repeat hepatic resection.