The prognostic significance of resection of primary tumor in gastric and colorectal cancer patients with synchronous liver metastasis

The significance of primary tumor resection in gastric and colorectal cancer patients with liver metastasis (H(+)) was evaluated in terms of operative mortality and survival rate by dividing the materials [293 gastric cancer and 80 colorectal cancer patients (53 colon and 27 rectum) with synchronous liver metastasis] into the following groups: Firstly, with or without peritoneal dissemination (P), secondly, with or without resection of the primary tumor and thirdly, with or without postoperative adjuvant chemotherapy. The following results were obtained: (1) The direct operative death rate of primary tumor resection, excluding death from other causes, showed an absence of statistically significant differences between the P₀H(+) and P(+)H(+) gastric and colorectal cancer patients. (2) There was no significance in the prognosis between the primary tumor resection + postoperative chemotherapy group and the non-resectable group in the P(+)H(+) gastric and colorectal cancer patients, revealing no prognostic value of the primary tumor. (3) In the P₀H(+) gastric and colorectal cancer patients, the primary tumor resection + postoperative chemotherapy group was significantly more favorable in prognosis than was the primary tumor resection alone group or the non-resectable group, showing the value of primary tumor resection.     

The prognostic significance of resection of primary tumor in gastric and colorectal cancer patients with synchronous liver metastasis

The significance of primary tumor resection in gastric and colorectal cancer patients with liver metastasis (H(+)) was evaluated in terms of operative mortality and survival rate by dividing the materials [293 gastric cancer and 80 colorectal cancer patients (53 colon and 27 rectum) with synchronous liver metastasis] into the following groups: Firstly, with or without peritoneal dissemination (P), secondly, with or without resection of the primary tumor and thirdly, with or without postoperative adjuvant chemotherapy. The following results were obtained: (1) The direct operative death rate of primary tumor resection, excluding death from other causes, showed an absence of statistically significant differences between the P0H(+) and P(+)H(+) gastric and colorectal cancer patients. (2) There was no significance in the prognosis between the primary tumor resection + postoperative chemotherapy group and the non-resectable group in the P(+)H(+) gastric and colorectal cancer patients, revealing no prognostic value of the primary tumor. (3) In the P0H(+) gastric and colorectal cancer patients, the primary tumor resection + postoperative chemotherapy group was significantly more favorable in prognosis than was the primary tumor resection alone group or the non-resectable group, showing the value of primary tumor resection.     

结直肠癌同时性肝转移治疗46例分析

目的:探讨结直肠癌同时性肝转移的有效治疗方法。方法:对1996～2004年收治的46例结直肠癌同时性肝转移的临床资料和随访资料进行回顾性分析。根据治疗方法的不同分为3组:A组21例,为一期切除原发灶和肝转移灶并经肝动脉和门静脉置泵化疗者;B组15例,为单纯原发灶切除并经肝动脉和门静脉置泵化疗者;C组10例,为原发灶和肝转移灶均未能切除而仅行肝动脉和门静脉置泵化疗者。用KaplanMeier法对病人的生存时间作统计分析。结果:A、B、C3组术后中位生存期分别为38、20和13个月;各组之间术后生存时间的比较均有显著统计学差异(P<0.01)。结论:结直肠癌原发灶和肝转移灶一期手术切除并经肝动脉和门静脉置泵化疗的疗效最好;肝转移灶无法切除者能将原发灶切除并经肝动脉和门静脉置泵化疗也可取得较好的疗效;原发灶和肝转移灶未能切除而仅经肝动脉和门静脉置泵化疗的疗效相对较差。对结直肠癌同时性肝转移应采取以手术切除为主的综合措施进行积极治疗。     

胃癌肝转移外科治疗的临床分析

目的 评价胃癌肝转移的外科治疗效果及病理因素对其预后的影响。方法 本组834例胃癌患者中共有91例诊断为肝转移，其中79例为同时性肝转移，12例术后发现异时转移，共21例行胃癌肝转移灶切除术。结果 胃癌肝转移灶切除后1年、3年生存率分别为69％、30％。单转移灶及异时性转移是其有利的预后因素。13例肝转移灶有假包膜形成。结论 单转移灶及异时转移、肿瘤假包膜形成预示胃癌肝转移切除患者有较好的预后。     

Hepatic Resection for Metastatic Tumors From Gastric Cancer

OBJECTIVE: To assess the surgical results and clinicopathologic features of hepatic metastases from gastric adenocarcinoma to identify patients with a better probability of survival. SUMMARY BACKGROUND DATA: Many studies have reported the benefit of hepatic resection for metastatic tumors from colorectal cancer. However, indications for a surgical approach for gastric adenocarcinoma involving the liver have not been clearly defined. METHODS: Ninety (11%) of 807 patients with primary gastric cancer were diagnosed with synchronous (n = 78) or metachronous (n = 12) hepatic metastases. Of these, 19 underwent 20 resections intended to cure the metastatic lesion in the liver. The clinicopathologic features of the hepatic metastases in, and the surgical results for, the 19 patients were analyzed. RESULTS: The actuarial 1-year, 3-year, and 5-year survival rates after hepatic resection were, respectively, 77%, 34%, and 34%, and three patients survived for more than 5 years after surgery. Solitary and metachronous metastases were significant determinants for a favorable prognosis after hepatic resection. Pathologically, a fibrous pseudocapsule between the tumor and surrounding hepatic parenchyma was found in 13 of the 19 patients (68%). The presence of a peritumoral fibrous pseudocapsule and a well-differentiated histologic type of metastatic nodule were significant prognostic factors. Factors associated with the primary lesion were not significant prognostic determinants in patients who underwent curative resection of the primary cancer. CONCLUSIONS: Solitary and metachronous metastases from gastric cancer should be treated by a surgical approach and confer a better prognosis. A new prognostic factor, the presence of a pseudocapsule, may be helpful in defining indications for postoperative adjuvant treatment.     

转移性肝癌的治疗理念和策略

转移性肝癌是恶性肿瘤发展的终末阶段,是导致患者死亡的主要原因,其中胃肠道是常见的原发癌部位。人们正尝试通过根治转移性肝癌或控制其发展等多种治疗策略,延长患者生存期。手术治疗、全身化疗、分子靶向治疗、射频消融术、门静脉栓塞术、肝动脉导管栓塞术是转移性肝癌的有效治疗方法,其中手术治疗是转移性肝癌可能获得治愈的有效手段。相比结肠癌肝转移癌,胃癌肝转移癌的治疗正处于探索阶段,但是随着新型有效化疗药物及化疗方案的出现、肝转移癌手术适应证的拓展以及大规模多中心临床试验循证医学证据的涌现,包括胃癌肝转移在内的转移性肝癌的治疗必将朝着一个更加规范,更为有效的方向发展。     

结直肠癌伴同时性肝转移的治疗

目的 探讨结直肠癌伴同时性肝转移患者的临床相关病理因素以及手术治疗.方法 回顾性分析1994年8月至2006年12月收治患者的临床资料及随访结果,比较结直肠癌无肝转移和有同时性肝转移患者的病理特点及不同程度肝转移患者和不同手术处理的预后.结果 2019例原发性结直肠癌患者中发生同时性肝转移者166例(8.10%).多因素分析显示:术前CEA水平、Ducks分期、肿瘤分化程度与浆膜浸润是同时性肝转移发生的高危因素;同时性肝转移术后1、3、5年生存率分别为69%、21%、9%;不同程度肝转移(H1、H2、H3)组间预后差异有统计学意义(X2=23.35,P<0.01).根治性手术切除组总体生存率明显高于姑息切除和未能切除组生存率(X2=21.18,P<0.01);姑息切除组和未切除组近期生存率差异有统计学意义(P<0.01),远期生存率差异无统计学意义(P=0.13).结论 结直肠癌伴同时性肝转移患者肝转移程度不同预后也不同.能够根治性切除的结直肠癌伴同时性肝转移预后较好,姑息切除原发病灶可提高近期预后和生活质量.     

肝切除治疗结直肠癌肝转移预后影响因素研究进展

结直肠癌是我国最常见的恶性肿瘤之一。临床上,结直肠癌病人首次确诊时已有15%～25%发生肝脏转移,中位生存期约为6个月,然而行手术切除肝转移灶后5年存活率可达60%。近年来,虽然在新辅助化疗和外科技术等方面取得迅速发展,使得病人获得较长的生存时间,但肝切除仍是治愈结直肠癌肝转移（CRLM）病人的主要治疗方式。肝切除术能够改善病人预后,手术应做到R0切除或者达到无疾病证据状态（NED）;若有复发应积极施行二次手术;原发病灶部位以及淋巴结转移情况对预后影响尚有待研究;结直肠癌确诊至发生肝转移时间间隔越长预后较好（＞2年）。然而,肝转移灶的大小、数目、部位情况等,并不是影响手术预后的主要因素。总之,肝切除对CRLM病人具有良好的预后,同时需要结合病人的切缘状态、残余肝体积、原发病灶及淋巴结转移等因素综合考虑。     

Clinicopathologic features of gastric cancers producing alpha-fetoprotein

BACKGROUND: Patients with gastric cancers producing alpha-fetoprotein (AFP) were reported to have a poor prognosis with high rates of liver metastasis. The purpose of the present study was to clarify the clinicopathological features of AFP-producing gastric cancers, in particular characteristics of liver metastasis, and to evaluate treatment of these cancers. METHODS: In 27 of the 29 cases with elevated preoperative serum AFP levels among a total of 974 primary gastric cancers, AFP production was confirmed in gastric cancer cells by immunohistochemistry. These cases were included in the AFP-positive gastric cancer group (AFP(+), 2.7%). The remaining 945 cases with normal serum AFP levels were designated the AFP-negative gastric cancer group (AFP(-)). RESULTS: There was a higher incidence of lymph node metastasis, a deeper invasion of the gastric wall, a higher frequency of advanced stage, a more marked lymphatic invasion and a higher rate of liver metastasis in the AFP(+) group than in the AFP(-) group. The patients received curative resection in AFP(+) group had a significantly worse survival rates in comparison to that in AFP(-) group. With respect to liver metastasis (n = 17) in AFP(+) group, of 3 cases who received curative hepatic resection, 1 patient survived more than 3 years, while the remaining 2 died in less than 3 years due to multiple liver recurrence. The patients (n = 5) who received palliative resection for liver metastasis followed by transarterial continuous infusion chemotherapy all died in less than 1 year. CONCLUSION: AFP-producing gastric cancers had aggressive behavior and their clinical or biological features were quite different from the common AFP-negative gastric cancers. Surgical resection of liver metastasis from AFP-producing gastric cancers was unsatisfactory. The development of a novel multimodal therapy against AFP-producing gastric cancers is needed.     

肝切除治疗结直肠癌肝转移预后影响因素研究进展

结直肠癌是我国最常见的恶性肿瘤之一。临床上，结直肠癌病人首次确诊时已有15%～25%发生肝脏转移，中位生存期约为6个月，然而行手术切除肝转移灶后5年存活率可达60%。近年来，虽然在新辅助化疗和外科技术等方面取得迅速发展，使得病人获得较长的生存时间，但肝切除仍是治愈结直肠癌肝转移（CRLM）病人的主要治疗方式。肝切除术能够改善病人预后，手术应做到R0切除或者达到无疾病证据状态（NED）；若有复发应积极施行二次手术；原发病灶部位以及淋巴结转移情况对预后影响尚有待研究；结直肠癌确诊至发生肝转移时间间隔越长预后较好（＞2年）。然而，肝转移灶的大小、数目、部位情况等，并不是影响手术预后的主要因素。总之，肝切除对CRLM病人具有良好的预后，同时需要结合病人的切缘状态、残余肝体积、原发病灶及淋巴结转移等因素综合考虑。     

结直肠癌肝转移的外科治疗

目的　探讨结、直肠癌肝转移的外科治疗。方法　对１９９３ 年１ 月至１９９９ 年１ 月的１９ 例结、直肠癌肝转移患者行外科治疗。其中６ 例同期切除,１０ 例分期切除,１ 例肝动脉结扎加无水乙醇注射,２ 例通过肝动脉结扎加化学药物治疗（化疗） 泵灌注化疗而获得二期手术切除机会。手术方式行肝不规则楔形切除１６ 例,左半肝切除２ 例。结果　术后１、３、５ 年生存率分别为８９％ 、５８％ 、２１％ 。６ 例同期肝切除者平均生存期２３ 个月,１０ 例分期肝切除者的平均生存期为３２ 个月。结论　掌握手术时机和适应证,积极进行肝动脉灌注化疗,提高手术切除成功率是提高存活率的关键。     

外科治疗胃癌肝转移疗效分析

目的探讨外科治疗胃癌肝转移的方法与疗效。方法1996年1月至2003年12月间行外科治疗的胃癌肝转移患者25例，17例为同时性肝转移，8例为术后发现的异时性肝转移。其中单转移灶15例，多转移灶10例。行不规则肝切除16例，左外叶切除4例，左叶切除3例，右叶切除2例，术后行肝动脉灌注化疗9例，肝动脉化疗栓塞16例。结果1例同时性肝切除患者术后死于肺部感染、成人呼吸窘迫综合征，余24例均获随访，中位时间25(7—60)个月。胃癌肝转移灶切除后1、3年生存率为68．5％和29．8％，原发癌浸润表浅、淋巴结转移少、单转移灶、异时性转移及转移灶有包膜是影响生存率的有利因素。结论同时及异时性胃癌肝转移可经外科手术切除肝转移灶，但应注意手术指征的把握。     

围手术期化疗与术后化疗对行手术切除晚期胃癌病人预后影响对比研究

目的 研究围手术期化疗与术后化疗对行手术切除晚期胃癌病人的预后影响。 方法 回顾性分析2004年1月至2016年12月南方医科大学南方医院普通外科行胃切除手术治疗的Ⅳ期胃癌病人资料。其中,行手术切除联合术后辅助化疗228例（术后化疗组,A 组）,行术前化疗+手术切除+术后化疗49例（围手术期化疗组,B组）。采用倾向得分匹配法（PSM）均衡组间混杂因素的影响,选取8个协变量进行1∶1匹配 (性别、年龄、肿瘤生物学分类、化疗完成度、术后病理的肿瘤浸润深度分期、淋巴结转移分期、淋巴结清扫范围、胃切除范围),最终49例A组病人和49例B组病人成功进行匹配。采用Kaplan-Merier法进行生存分析,应用Cox比例风险回归模型对行手术切除的晚期胃癌病人进行独立生存危险因素的分析。 结果 匹配前,两组病人的肿瘤生物学分类（P<0.001）、化疗周期（P<0.001）、肿瘤浸润深度分期（P<0.001）、淋巴结转移分期（P=0.049）、淋巴结清扫范围（P=0.001）、胃切除范围（P=0.001）等差异有统计学意义,而匹配之后,仅有化疗完成度（P<0.001）在两组间差异有统计学意义,B组的化疗完成度优于A组。匹配之后,A组中位生存时间（MST）为16个月（95%CI 10.36～21.64）,与B组MST 29个月（95%CI 17.24～40.76）之间差异无统计学意义（P=0.191）。生存单因素分析显示,生物学分类、化疗周期、淋巴结转移情况和淋巴结清扫情况等四个因素可影响行手术切除晚期胃癌病人的生存预后,进一步多因素分析提示,化疗周期≤2次,淋巴结转移、淋巴结清扫范围不足D2等3个因素为独立预后不良因素。化疗与手术的先后次序（围手术期化疗相比术后化疗）并不影响病人生存预后（HR 0.986,95%CI 0.539～1.806,P=0.964）。 结论 相比术后化疗,围手术期化疗并不是改善行手术切除晚期胃癌病人生存预后的独立因素,但能够使病人有更好的化疗耐受性和依从性,从而使其生存显著优于术后开始化疗的病人。这可为后续晚期胃癌治疗的前瞻性研究设计提供参考和指导。     

原发性胃弥漫大B细胞淋巴瘤38例临床预后分析

目的探讨原发性胃弥漫大B细胞淋巴瘤(PG-DLBL)的外科手术治疗的意义。方法回顾性分析我院1996年1月至2007年12月经胃镜活检或手术病理证实的38例PG-DLBL患者的临床病理κ料,根据治疗情况分为手术联合化疗组㈦单纯化疗组,比较两组预后情况。结果手术联合化疗17例,单纯化疗21例。两组发病年龄、性别、肿瘤分期、肿瘤大小均无显著性差异,手术联合化疗组的5年生存率为56%,单纯化疗组为33%,差异无统计学意义(P=0.676)。单纯化疗组并发消化道出血1例。手术联合化疗组的完全缓解率为94.1%,单纯化疗组为81.0%(P=0.233)。结论手术不应是PG-DLBL的首选治疗措施。     

手术方式对不同腹腔转移类型胃癌预后的影响

目的 比较手术方式对不同腹腔转移类型胃癌预后的影响.方法 本组胃癌伴腹腔转移150例,按转移部位不同分为腹膜种植组(106例)、肝转移组(19例)、腹膜种植并肝转移组(25例).手术方法包括病灶全切除、病灶姑息切除、非病灶切除术,部分病例行淋巴结清扫.结果 腹膜种植组、肝转移组、腹膜种植并肝转移组的病灶全切除率分别为48.1%、63.2%和20.0%,淋巴结清扫率分别为48.1%、68.4%和20.0%,腹膜种植组和肝转移组显著高于腹膜种植并肝转移组(P<0.05),腹膜种植并肝转移组以病灶姑息切除(48.0%)和非淋巴结清扫术(80.0%)为主.腹膜种植组、肝转移组、腹膜种植并肝转移组的平均生存期分别为31.1、12.8、9.7个月,腹膜种植组预后最好,腹膜种植并肝转移组最差(P<0.05).腹膜种植组接受病灶全切除、病灶姑息切除、非病灶切除的平均生存期分别为46.3、17.7、4.8个月,各组之间差异均有统计学意义(P<0.05);肝转移组病灶全切除、病灶姑息切除、非病灶切除的平均生存期分别为17.2、4.0、5.4个月,病灶全切除能显著延长患者生存期(P<0.05);腹膜种植并肝转移组行病灶全切除、病灶姑息切除、非病灶切除的平均生存期分别为11.2、8.9、5.0个月,差异均无统计学意义(P>0.05).淋巴结清扫可显著延长腹膜种植组的生存期(P<0.05).结论 胃癌发生腹膜种植患者的预后比发生肝转移患者的好,病灶切除和规范的淋巴结清扫可改善腹膜种植或肝转移胃癌患者的预后.     

Repeated hepatic intra-arterial chemotherapy based on results of anticancer drug sensitivity test in patients with synchronous hepatic metastases from colorectal cancer

OBJECTIVE: We determined whether hepatic intra-arterial infusion of 5-fluorouracil (5-FU) in patients with synchronous hepatic metastases from colorectal cancer, in whom the primary lesion was resectable but hepatic metastatic lesions were non-resectable helped improve survival time when administered on the basis of the results of the anticancer drug sensitivity test. PATIENTS AND METHODS: The study population consisted of 29 patients with synchronous hepatic metastases from colorectal cancer who underwent surgical resection of the primary lesion alone. Of these 29 patients, 21 received hepatic intra-arterial infusion of 5-FU postoperatively after the 5-FU sensitivity test. The remaining 8 patients underwent surgical resection of the primary lesion but neither sensitivity testing nor hepatic intra-arterial chemotherapy. Tissue fragments were cultured, with each concentration of 5-FU in the thermoreversible gelation polymer forming a three-dimensional structure at 37 degrees C. The viability of tumor cells was evaluated according to WST methods; inhibitory concentration of 50% (IC50) values were calculated. We considered cancer tissue to be sensitive to IC50 values that were below twice the peak plasma concentration (120 microg/ml). RESULTS: Of the 21 patients, 10 had sensitivity to 5-FU and 11 had no sensitivity. The response rates were 90.0% and 9.1%, respectively. The median survival times were 38 months and 10 months in these groups, respectively, and 7 months in patients who received no chemotherapy. This finding indicates a significantly longer survival time in the sensitive group, compared with either the insensitive group or the no chemotherapy group (P = .0014 P = .0023). The cumulative survival rate was significantly higher in the sensitive group compared with the insensitive group (P = .0001) CONCLUSIONS: Ultimately, the group with sensitivity to 5-FU showed a significantly longer median survival time than the insensitive group.     

Treatment strategy for synchronous metastases of colorectal cancer: is hepatic resection after an observation interval appropriate?

Background In cases of synchronous colorectal hepatic metastases, the primary colorectal cancer strongly influences on the metastases. Our treatment policy has been to conduct hepatic resection for the metastases at an interval of 3 months after colorectal resection. We examined the appropriateness of interval hepatic resection for synchronous hepatic metastasis. Materials and methods The subjects were 164 patients who underwent resection of hepatic metastasis of colorectal cancer (synchronous, 70 patients; metachronous, 94 patients). Background factors for hepatic metastasis and postoperative results were compared for synchronous and metachronous cases. Results The cumulative survival rate for 164 patients at 3, 5, and 10 years postoperatively was 71.9%, 51.8%, and 36.6%, and the post-resection recurrence rate in remnant livers was 26.8%. Interval resection for synchronous hepatic metastases was conducted in 49 cases after a mean interval of 131 days. No difference was seen in postoperative outcome between synchronous and metachronous cases. Conclusion The outcome was similarly favorable in cases of synchronous hepatic metastasis and in cases of metachronous metastasis. Delaying resection allows accurate understanding of the number and location of hepatic metastases, and is beneficial in determining candidates for surgery and in selecting surgical procedure.     

Nonoperative Management of Primary Colorectal Cancer in Patients With Stage IV Disease

Background: Traditional teaching maintains that patients with primary colorectal adenocarcinoma require timely resection to prevent bleeding, perforation, or obstruction. The true benefits of primary tumor resection remain undocumented for patients presenting with metastatic disease, however. We postulated that resection of primary colorectal tumors could be avoided safely in a select population of asymptomatic colorectal cancer patients presenting with incurable stage IV disease.Methods: A retrospective review of the Vanderbilt University Hospital tumor registry was performed for the years 1985 to 1997. During this period, 955 patients presented for management of primary colorectal cancer. From this group, all patients with stage IV disease at the time of diagnosis were identified. Patients who initially underwent resection of their primary lesion were included in the resection group; those who underwent initial nonoperative primary tumor management were included in the nonresection group. Data were obtained regarding age, extent of disease, nonsurgical therapy, tumor-specific complications, and palliative surgical procedures. Surgery-free survival and overall survival were analyzed using the Kaplan-Meier method. For patients with liver metastases, hepatic tumor burden was defined as either H1 (<25% parenchymal replacement), H2 (25% to 50%), or H3 (>50%) disease.Results: Sixty-six patients were included in the resection group, and 23 patients with intact asymptomatic primary colorectal lesions were included in the nonresection group. Among patients with hepatic metastases, most of the patients in both groups had H1 disease. Ten patients in the resection group and 3 patients in the nonresection group presented with exclusively extrahepatic metastases. In the nonresection group, primary therapy included chemotherapy in 13 patients, external beam radiation therapy in 1 patient, and combination chemoradiation in 9 patients. The median survival in the nonresection group was 16.6 months. The 2-year actuarial survival was 18%, and the surgery-free survival was 91.3%. Only 2 of 23 patients (8.7%) managed without resection eventually developed obstruction at the primary tumor site requiring emergent diversion. There were no episodes of tumor-related hemorrhage or perforation. For the resection group, the operative morbidity was 30.3%, and the perioperative mortality rate was 4.6%. The median survival in the resection group was 14.5 months (P = 0.59, log-rank test vs. nonresection group).Conclusions: Selected patients with asymptomatic primary colorectal tumors who present with incurable metastatic disease may safely avoid resection of their primary lesions, with an anticipated low rate of hemorrhage, perforation, or obstruction before death from systemic disease. No survival advantage is gained by resection of an asymptomatic primary lesion in the setting of incurable stage IV colorectal cancer.     

Validity of observation interval for synchronous hepatic metastases of colorectal cancer: changes in hepatic and extrahepatic metastatic foci

Background In cases of synchronous colorectal hepatic metastases, the primary colorectal cancer maintains a strong influence on the metastases, so the possibility of occult hepatic and extrahepatic metastases must be kept in mind. Our treatment policy has been to reevaluate the metastases at an interval of 3 months after colorectal resection and determine treatment strategy. We examined the validity of observation interval for synchronous hepatic metastases. Materials and methods The treatment course was investigated for 36 patients with no extrahepatic lesion remnants at colorectal surgery and a simultaneously resectable liver (H1 group). Results In the H1 group, eight patients underwent simultaneous colorectal and hepatic resections, while the treatment course for 28 patients was decided after an interval. Hepatic resection was not indicated in nine of the 28 patients during the interval. New lesions appeared during the interval in seven of 19 interval hepatic resection patients. In 16 (57%) of 28 interval patients, there was a change in the hepatic resection procedure or surgical indications. Conclusion Reevaluation after an observation interval allows accurate understanding of the number and location of hepatic metastases and is beneficial in determining candidates for surgery and in selecting treatment plan.     

结肠癌肝转移外科治疗的临床与病理分析(附25例报告)

目的　探讨结肠癌肝转移的外科治疗方法及其病理因素对预后的影响。方法　本组79例结肠癌肝转移患者中共有 2 5例接受原发灶根治术以及肝转移灶切除术或射频消融术。其中 14例进行了原发灶根治术及肝脏转移灶切除术 ,11例进行了肝脏转移灶射频消融术。结果　本组结肠癌肝转移患者术后 1年、3年生存率分别为 84 %、4 8%。分化程度高以及单个转移灶的患者预后较好。肝脏肿瘤切除与肝脏肿瘤射频消融术后患者生存时间无明显差异。结论　结肠癌肝转移患者原发肿瘤的分化程度、肝脏转移灶的数量对预测患者的预后有一定的作用。手术切除及射频消融术对治疗结肠癌肝转移能够达到较为接近的治疗效果。