同期肝切除治疗结直肠癌同时性肝转移

目的探讨结直肠癌同时性肝转移肝肠同期手术的疗效。方法回顾性分析1994年8月至2004年12月在我院行外科手术治疗的121例同时性结直肠癌肝转移患者的临床资料。结果在121例同时性结直肠癌肝转移患者中,99例行结直肠癌根治性切除术,剔除2例行原位肝移植患者后,同期肝切除组41例（A组）,对肝转移瘤行姑息外科治疗组56例（B组）,即转移瘤未能完全经手术切除者,A、B组患者性别、年龄、原发瘤部位、浸润深度、淋巴结转移等差异均无统计学意义,肝转移瘤数目（x^2=40.41,P＜0.05）、肝转移瘤分布（x^2=11.61,P＜0.05）差异有统计学意义;两组患者中位生存期分别为28.9个月、17.1个月,5年生存率分别为14％、0,其中A组患者中位无瘤生存期为19.5个月,1、3、5年生存率为93%、44%和14%。结论同期肝切除能为部分结直肠癌同时性肝转移患者提供治愈机会,对于合适的患者应力争行同期肝切除术。     

同时性结直肠癌肝转移一期切除术后并发症相关因素分析

目的:探讨同时性结直肠癌肝转移一期切除术后并发症的相关影响因素及预防措施。方法:2009年6月至2018年6月解放军总医院普通外科行同时性结直肠癌肝转移一期切除术的241例,统计并发症发生情况,分析影响因素,对危险因素进行评估分析。结果:241例行同时性结直肠癌肝转移一期切除术的患者术后共42例发生并发症,发生率为17.4%。其中,吻合口瘘19例(7.9%),腹腔出血7例(2.9%),肠梗阻15例(6.2%),切口感染21例(8.7%),腹腔感染6例(2.5%),肺部感染3例(1.2%)。单因素分析结果显示,高龄、手术方式、术前合并症、原发肿瘤位置、术中失血量是腹同时性结直肠癌肝转移一期切除术后并发症发生的相关因素(P<0.05)。Logistit回归分析显示,影响同时性结直肠癌肝转移一期切除术后并发症发生的独立危险因素为高龄、术前合并症、手术出血量(P<0.05),腹腔镜手术则是其保护因素(P<0.05)。结论:吻合口瘘和出血是同时性结直肠癌肝转移一期切除术后常见并发症,高龄、术前合并疾病、手术出血量较多是同时性结直肠癌肝转移一期切除术后并发症发生的危险因素,而采取腹腔镜手术则可减少并发症的发生。     

SNCG在结直肠癌肝转移中的表达及其临床意义

目的探讨SNCG在结直肠癌肝转移患者中的表达情况及其临床意义。方法收集1999年1月至2003年12月间中国医学科学院肿瘤医院收治的具有完整临床病理及随访资料的217例结直肠癌手术标本。其中113例伴肝转移,104例无肝转移。采用免疫组织化学染色检测SNCG在结直肠癌组织中的表达。分析SNCG表达与结直肠癌肝转移临床病理特征及预后的关系。结果肝转移组和无肝转移组患者结直肠癌组织中SNCG阳性表达率分别为68．1％（77／113）和27．9％（29／104）,差异有统计学意义（P〈0．05）。Logistic多因素分析显示,SNCG表达是判断结直肠癌是否伴有肝转移的独立因素（OR=8．29,95％CI：3．37～20．37,P〈0．01）。SNCG阳性表达与阴性表达的同时性肝转移患者术后中位生存时间分别为8．2个月和12．6个月．差异有统计学意义（P〈0．05）;Cox多因素分析显示,SNCG表达是结直肠癌同时性肝转移患者的独立预后因素（RR：1．97．95％CI：1．10—3．53,P〈0．05）。结论SNCG在肝转移患者的结直肠癌组织中高表达．SNCG表达不仅可以作为结直肠癌肝转移预示因子,也是同时性肝转移的重要预后因素。     

结直肠癌肝转移一期联合手术化疗的临床研究

目的探讨结直肠癌肝转移一期联合手术辅助化疗的有效途径及临床价值.方法回顾性分析一期联合手术切除原发癌及转移癌,经肝动脉门静脉双置泵栓塞灌注化疗,肿瘤局部注射无水酒精及热电疗法综合性治疗结直肠癌肝转移36例的临床资料.结果本组36例结直肠癌患者原发癌均获切除,其中一期切除肝转移癌17例,6例复发,4例再次手术切除.19例不能切除的转移性肝癌,行肝动脉门静脉双置泵栓塞灌注化疗,无水酒精注射和热电疗法.肿瘤直径平均缩小57%,其中4例因肿瘤缩小行二期手术切除.1、2、3年生存率分别为切除组94%,82%,65%;明显高于置泵组的74%,53%,32%(P<0.01).结论结直肠癌肝转移一期联合手术切除加肝动脉门静脉双置泵栓塞灌注化疗,是一种首选而有效的治疗方法.不能切除肝转移癌者,只要切除原发肿瘤,肝动脉门静脉置泵栓塞灌注化疗,可明显延长病人生存期,改善预后.     

结直肠癌同时性肝转移的同期手术切除

目的探讨同时性结直肠癌肝转移行同期切除原发瘤和肝转移瘤的安全性和有效性。方法回顾性总结分析从1981年5月至2005年11月在我院住院治疗的43例结直肠癌同时性肝转移同期手术的临床病理资料及结果并结合文献复习。结果43例患者中男性21例,女性22例,中位年龄52岁,手术持续中位时间180min。共30例术中输血,中位输血量800ml。术后总住院时间10—50d,中位时间15d。并发症发生率18．6％（8／43）,手术死亡率2．3％（1／43）。全组总的中位生存期为25个月,5年生存率19．1％。R0切除组的中位生存期48个月,5年生存率33．8％;非R0切除组的中位生存期为20个月,5年生存率7．6％。两组的生存时间经LogRank检验差异明显,P=0．002。结论同时性结直肠癌肝转移同期手术的安全性和有效性可以保证。对可切除的同时性结直肠癌肝转移应争取同期手术,并争取R0切除。     

结直肠癌同时性肝肺转移或者肝转移后发生肺转移的手术效果的评价

本研究旨在评估结直肠癌孤立肝、肺转移手术切除的有效性。共有256例患者因结直肠癌肝转移接受了肝切除术．其中31例患者伴同时性或异时性的肺转移。93．5％（29／31）的患者在肝切除术后发生肺转移,随后接受了肺叶切除术：6．5％（2／31）的患者在确诊肝转移时已发生同时性肺转移,并接受了分期的肝切除术和肺叶切除术。     

切缘宽度对结直肠癌肝转移同期肝切除患者术后生存的影响

目的探讨结直肠癌同期肝切除术合适的肝转移瘤切缘宽度。方法回顾性分析1994年8月至2004年12月行肝肠同期切除的39例同时性结直肠癌肝转移患者的临床资料,将患者根据肝转移瘤切缘宽度小于1cm和大于或等于1cm分为A、B两组,用Kaplan—Meier法进行生存分析,用Log-rank检验比较两组术后的生存期。结果A组患者14例,B组患者25例;两组患者性别、年龄、原发瘤浸润深度、淋巴结转移、肝转移瘤数目和分布及最大直径、手术时间和术中出血量比较．差异均无统计学意义（P〉0．05）。两组患者中位生存期分别为17和37个月（P〈0．01）,5年生存率分别为0和19．8％（P〈0．01）,差异有统计学意义。结论结直肠癌肝转移行同期肝切除术时应力争肝转移瘤切缘宽度大于或等于1cm。     

结直肠癌肝转移行肝切除术的疗效分析

目的:探讨结直肠癌肝转移行肝切除的疗效. 方法自1992年至2003年间,对22例结直肠癌肝转移患者行肝切除术,24例肝转移患者行全植入式 (drug deliverly system,DDS)灌注化疗,比较两组患者的治疗效果. 结果在22例行肝切除术的患者中,4例行左肝外叶切除术,3例行左半肝切除术,2例行右半肝切除术,2例行肝段切除术,7例行亚肝段切除术,瘤体局部切除4例.术后1年、3年、5年生存率分别为86.36%、40.91%和31.82% .24例行DDS灌注化疗患者的1年、3年、5年生存率分别为63.64%、12.50%和4.17%. 结论结直肠癌肝转移行各种肝切除术能改善患者的生活质量,延长生存时间.     

结直肠癌同时肝转移和腹膜转移的处理及预后

目的 探讨结直肠癌同时性肝转移和腹膜扩散患者的相关临床病理因素以及手术干预对其预后的影响.方法 回顾性分析12年间中山大学附属第一医院肠癌数据库资料中有同时性肝转移和/或腹膜扩散患者(166例/150例)的临床病例资料及随访结果.结果 在诸多病理因素中肿瘤分化程度和浆膜浸润与腹膜扩散有关(P<0.01),而肿瘤分化程度,浆膜浸润和Ducks分期等与同时性肝转移有关(P<0.01);手术不可切除的结直肠癌伴同时性肝转移组与伴腹膜扩散组的短期和长期生存率差异无统计学意义(P>0.05),而在手术可切除组中伴腹膜扩散者的长期生存率优于伴肝转移者(P<0.01).结论 结直肠癌腹膜转移患者较同时性肝转移患者长期顶后好;手术不可切除的结直肠癌伴腹膜扩散或肝转移才标示着肿瘤的终末期;结直肠癌伴腹膜转移根治切除组较伴同时性肝转移根治切除组预后好,局限的结直肠癌伴腹膜转移通过手术可能得到根治.     

结直肠癌肝转移复发再次肝切除术的疗效与预后分析

目的 探讨再次肝切除术在结直肠癌肝转移复发治疗中的应用价值.方法 回顾性分析43例结直肠癌肝转移复发再次肝切除术和67例结直肠癌肝转移复发内科化疗的临床资料.结果 结直肠癌肝转移复发再手术组和化疗组1,3,5年生存率分别为83.7％,51.1％,27.9％和65.7％,20.6％,3.0％(P＜0.05或P＜0.01).再次肝切除组无手术死亡病例,并发症发生率为32.6％.单因素分析显示肝脏复发转移灶个数,切缘情况,CEA,肿瘤大小,肿瘤分化程度与预后有关.多因素回归分析结果表明,仅有肝脏复发转移灶个数和肿瘤大小为影响预后的独立因素.结论 再次肝切除术对于结直肠癌肝转移复发是安全的治疗方案,肿瘤负荷较小(癌直径＜5 cm和转移灶＜3个)的患者预后较好;再次手术可以延长结直肠癌肝转移复发患者的生存时间.     

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??Safety and efficacy of simultaneous resection and staged resection for synchronous colorectal liver metastases??A Meta analysis WEI Meng??GENG Xiao-ping??ZHAO Hong-chuan??et al. Department of Organ Transplantation??the First Affiliated Hospital of Anhui Medical University??Hefei 230022??China
Corresponding author??GENG Xiao-ping??E-mail??xp_geng@163.net
Abstract Objective To evaluate the safety and efficacy of simultaneous resection and staged resection for synchronous colorectal liver metastasis (SCLM). Methods Medline??Cochrane Library and Google Scholar were searched from December 1999 to May 2012 to identify the case-control studies comparing outcomes following simultaneous resection and staged resection for SCLM. Results Fourteen case-control studies with a total of 2588 patients of SCLM undergone curative hepatic resection were reviewed. There were 931 simultaneous and 1657 staged resections. Complication incidence in simultaneous resection group was lower than that in staged resection group (41.1% vs. 44.8%)??and the difference was statistically significant (OR 0.79??95%CI??0.65??0.95??P=0.01). Less blood loss (P=0.02) and shorter hospital stay (P=0.00) were observed in simultaneous resection group. No significant difference was found in perioperative mortality rate (P=0.26), 3 years tumor-free survival rate (P=0.19), 5 years overall survival rate (P=0.86) and operative time (P=0.05) between two groups. Particularly??for major liver resections (resection of three or more segments)??the surgical complication incidence (P=0.26) and perioperative mortality rate (P=0.26) in the simultaneous resection group have not statistical difference compared with that in the staged resection group. Conclusion Simultaneous resection is safe and efficient in the treatment of patients with SCLM who can undergo staged resection. In appropriately selected patients??simultaneous resection might be considered as the preferred treatment.     

Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis

BACKGROUND: The optimal surgical strategy for the treatment of synchronous resectable colorectal liver metastasis has not been defined. The aims of this study were to review our experience with synchronous colorectal metastasis and to define the safety of simultaneous versus staged resection of the colon and liver. STUDY DESIGN: From September 1984 through November 2001, 240 patients were treated surgically for primary adenocarcinoma of the large bowel and synchronous hepatic metastasis. Clinicopathologic, operative, and perioperative data were reviewed to evaluate selection criteria, operative methods, and perioperative outcomes. RESULTS: One hundred thirty-four patients underwent simultaneous resection of a colorectal primary and hepatic metastasis in a single operation (Group I), and 106 patients underwent staged operations (Group II). Simultaneous resections tend to be performed for right colon primaries (p < 0.001), smaller (p < 0.01) and fewer (p < 0.001) liver metastases, and less extensive liver resection (p < 0.001). Complications were less common in the simultaneous resection group, with 65 patients (49%) sustaining 142 complications, compared with 71 patients (67%) sustaining 197 complications for both hospitalizations in the staged resection group (p < 0.003). Patients having simultaneous resection required fewer days in the hospital (median 10 days versus 18 days, p = 0.001). Perioperative mortality was similar (simultaneous, n = 3; staged, n = 3). CONCLUSIONS: Simultaneous colon and liver resection is safe and efficient in the treatment of patients with colorectal cancer and synchronous liver metastasis. By avoiding a second laparotomy, the overall complication rate is reduced, with no change in operative mortality. Given its reduced morbidity, shorter treatment time, and similar cancer outcomes, simultaneous resection should be considered a safe option in patients with resectable synchronous colorectal metastasis.     

结直肠癌同时性肝转移同期与分期手术切除疗效比较

目的：比较结直肠癌同时性肝转移患者原发灶和肝转移灶同期与分期切除的近期和远期结局。方法回顾性分析北京肿瘤医院肝胆胰外一科2003年1月至2011年12月间的64例结直肠癌合并同时性肝转移患者的临床及术后随访资料,其中行原发灶和肝转移灶同期切除者20例（同期切除组）,分期切除者44例（分期切除组）。结果同期切除组Clavien-Dindo 1、2和3级并发症发生率分别为10．0％（2/20）、15．0％（3/20）和15．0％（3/20）,分期切除组分别为13．6％（6/44）、13．6％（6/44）和22．7％（12/44）,差异无统计学意义（P＞0．05）。同期切除组1、2和3年总体生存率分别为85．0％、59．6％和37．2％,分期切除组分别为90．9％、68．2％和47．1％,差异亦无统计学意义（均P＞0．05）。两组中位无病生存时间分别为6月和7月,差异亦无统计学意义（P＞0．05）。多因素预后分析显示,原发灶淋巴结阳性（P=0．020）和肝切除术前CEA水平大于20μg/L（P=0.017）是影响患者总体生存的独立危险因素;复发后有机会接受根治性局部治疗联合化疗则是一项保护性因素（P=0.001）;而手术时机（同期或分期切除）与患者总体生存无关（P＞0．05）。结论对于结直肠癌同时性肝转移,选择同期或分期切除并不影响患者的术后并发症发生率和远期生存率。     

Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Multi-institutional Analysis

Background The safety of simultaneous resections of colorectal cancer and synchronous liver metastases (SCRLM) is not established. This multi-institutional retrospective study compared postoperative outcomes after simultaneous and staged colorectal and hepatic resections. Methods Clinicopathologic data, treatments, and postoperative outcomes from patients who underwent simultaneous or staged colorectal and hepatic resections at three hepatobiliary centers from 1985–2006 were reviewed. Results 610 patients underwent simultaneous (n = 135) or staged (n = 475) resections of colorectal cancer and SCRLM. Seventy staged patients underwent colorectal and hepatic resections at the same institution. Simultaneous patients had fewer (median 1 versus 2) and smaller (median 2.5 versus 3.5 cm) metastases and less often underwent major (≥ three segments) hepatectomy (26.7% versus 61.3%, p < 0.05). Combined hospital stay was lower after simultaneous resections (median 8.5 versus 14 days, p < 0.0001). Mortality (1.0% versus 0.5%) and severe morbidity (14.1% versus 12.5%) were similar after simultaneous colorectal resection and minor hepatectomy compared with isolated minor hepatectomy (both p > 0.05). For major hepatectomy, simultaneous colorectal resection increased mortality (8.3% versus 1.4%, p < 0.05) and severe morbidity (36.1% versus 15.1%, p < 0.05). Combined severe morbidity after staged resections was lower compared to simultaneous resections (36.1% versus 17.6%, p = 0.05) for major hepatectomy but similar for minor hepatectomy (14.1% versus 10.5%, p > 0.05). Major hepatectomy independently predicted severe morbidity after simultaneous resections [hazard ratio (HR) = 3.4, p = 0.008]. Conclusions Simultaneous colorectal and minor hepatic resections are safe and should be performed for most patients with SCRLM. Due to increased risk of severe morbidity, caution should be exercised before performing simultaneous colorectal and major hepatic resections.     

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.     

Selection criteria for simultaneous resection in patients with synchronous liver metastasis

HYPOTHESIS: While simultaneous resection has been shown to be safe and effective in patients with synchronous metastasis, neoadjuvant chemotherapy followed by hepatectomy has gradually gained acceptance for both initially nonresectable metastasis and resectable metastasis. The boundary between these treatments is becoming unclear. We hypothesized that factors associated with colorectal cancer may play an important role in the prognosis of patients with synchronous metastasis and may be useful for identifying patients who can be expected to have adequate results following simultaneous resection. DESIGN: Outcome study. SETTING: Tertiary referral center. PATIENTS: From January 1980 to December 2002, 187 patients underwent curative resection for synchronous liver metastasis from colorectal cancer. One hundred forty-two patients received simultaneous resection, 18 underwent staged resection, and 27 underwent delayed hepatic resection. Twenty-one clinicopathological factors were analyzed, and long-term prognosis was assessed. MAIN OUTCOME MEASURES: Prognostic factors and patient survival. RESULTS: There was no in-hospital death. In a multivariate analysis, the factors that significantly affected the prognosis of synchronous metastasis were 4 or more lymph node metastases around the primary cancer (P<.001) and multiple liver metastases (P = .003). In patients with 3 or fewer lymph node metastases around the primary cancer, the 5-year survival rates of those with 1, 2 to 3, and 4 or more liver metastases were 63%, 33%, and 40%, respectively, but these rates were 15%, 22%, and 0%, respectively, in patients with 4 or more lymph node metastases around the primary cancer. CONCLUSIONS: The results support the application of simultaneous resection in patients with 0 to 3 colorectal lymph node metastases. However, in patients with 4 or more colorectal lymph node metastases, biological selection by neoadjuvant chemotherapy may be more suitable.     

Totally laparoscopic strategies for the management of colorectal cancer with synchronous liver metastasis

Introduction

Laparoscopy is an accepted treatment for colorectal cancer and liver metastases, but there is no consensus for its use in the management of synchronous liver metastases (SCRLM). The purpose of this study was to evaluate totally laparoscopic strategies in the management of colorectal cancer with synchronous liver metastases.

Methods

Patients presenting to Ninewells Hospital between July 2007 and August 2010, with adenocarcinoma of the colon and rectum with synchronous liver metastases were considered. Patients underwent simultaneous laparoscopic liver and colon cancer resection, a staged laparoscopic resection of SCRLM and colon cancer, or simultaneous colon resection and radiofrequency ablation (RFA) of SCRLM. Primary endpoints were in-hospital morbidity and mortality, total hospital stay, intraoperative blood loss, duration of surgery, and resection margin status.

Results

Twenty-eight patients presented with synchronous colorectal liver metastases. Thirteen patients underwent a simultaneous laparoscopic liver and colon resection (median operating time, 370 (range, 190–540) min; median hospital stay, 7 (range, 3–54) days), seven patients had a staged laparoscopic resection of SCRLM and primary colon cancer (median operating time, 530 (range, 360–980) min; median hospital stay 14, (range, 6–51) days), and eight patients underwent laparoscopic colon resection and RFA of SCRLM (median operating time, 310 (range, 240–425) min; median hospital stay, 8 (range, 6–13) days). There were no conversions to an open procedure. Overall in-hospital morbidity and mortality was 28 and 0?% respectively. An R0 resection margin was achieved in 91?% of the resection group. At a median follow-up of 26 (range, 18–55) months, 19 (90?%) patients remain disease-free.

Conclusions

Totally laparoscopic strategies for the radical treatment of stage IV colorectal cancer are feasible with low morbidity and favorable outcomes. A laparoscopic approach for the simultaneous management of SCRLM and primary colon cancer is associated with reduced surgical access trauma, postoperative morbidity, and hospital stay with no compromise in short-term oncological outcome.     

Laparoscopic resection of colon cancer and synchronous liver metastasis

The recommended surgical approach to synchronous colorectal metastasis has not been clarified. Simultaneous open liver and colon resection for synchronous colorectal carcinoma has been shown beneficial when compared to staged resections. A review of the literature has shown the benefits of both laparoscopic colon resection for colorectal cancer and laparoscopic left lateral segmentectomy in liver disease. We present the case of a 60-year-old male with sigmoid colon carcinoma and a synchronous solitary liver metastasis localized to the left lateral segment. Using laparoscopic techniques, we were able to achieve simultaneous resection of the sigmoid colon and left lateral liver segment.     

Surgical treatment of liver metastases from colorectal cancer

We analyze our experience over a 10-year period in the surgical treatment of liver metastases from colorectal cancer. Between 01.01.1995 and 08.31.2005 189 liver resections were performed in 171 patients with liver metastases from colorectal cancer (16 re-resections - 2 in the same patient and a "two-stage" liver resection in 2 patients). In our series there were 83 patients with synchronous liver metastases (69 simultaneous resections, 12 delayed resections and 2 "two-stage" liver resection were performed) and 88 metachronous liver metastases. Almost all types of liver resections have been performed. The morbidity and mortality rates were 17.4% and 4.7%, respectively. Median survival was 28.5 months and actuarial survival at 1-, 3- and 5-year was 78.7%, 40.4% and 32.7%, respectively. Between January 2002 and August 2005 hyperthermic ablation of colorectal cancer liver metastases has been performed in 6 patients; in other 5 patients with multiple bilobar liver metastases liver resection was associated with radiofrequency ablation and one patient underwent only radiofrequency ablation for recurrent liver metastasis. In conclusion, although the treatment of colorectal cancer liver metastases is multimodal (resection, ablation, chemotherapy and radiation therapy), liver resection is the only potential curative treatment. The quality and volume of remnant liver parenchyma is the only limitation of liver resection. The morbidity, mortality and survival rates after simultaneous liver and colorectal resection are similar with those achieved by delayed resection. Postoperative outcome of patients with major hepatic resection is correlated with the surgical team experience. The long-term survival was increased using the new multimodal treatment schemes.