胃癌同时性肝转移手术患者的预后分析

目的分析经手术治疗的胃癌同时性肝转移患者的预后因素。方法回顾性分析1998年1月至2012年12月间在大连医科大学附属第一医院胃肠外科手术治疗的胃癌同时性肝转移53例患者的临床病理学资料,对单发和多发肝转移患者的生存率进行比较并进行预后分析。结果本组53例患者5年总体生存率为11．3％。单发肝脏转移患者34例,5年生存率14．7％,明显高于19例多发肝转移患者的0（P=-0．000）。单因素分析结果显示,浆膜侵犯（P=0．000）、淋巴结转移（P=0．000）、手术根治度（P=0．044）、发生肝转移数目（P=0．000）和肝转移肿瘤直径（P=0．031）是影响胃癌肝转移患者预后的因素。其中浆膜侵犯（RR：3。355,P=0．012）和肝转移数目（RR：7．664,P=0．000）是影响胃癌肝转移患者预后的独立因素。结论手术治疗可以提高无浆膜侵犯的胃癌单发肝转移患者的预后。     

结肠癌伴肝转移同期切除影响预后相关因素分析

目的 探讨结肠癌伴肝转移行同期切除影响病人预后的相关因素。方法 回顾性分析2002年1月至2008年6月第二军医大学附属东方肝胆外科医院综合治疗三科结肠癌伴肝转移行同期切除59例的临床资料。结果 年龄、性别、CEA水平、门静脉化疗泵内局部化疗及肝转移灶大小、数目和位置对病人生存时间具有影响。结论 肝肿瘤的大小、位置、数目、CEA水平虽对预后有影响,但均为不可控因素,而术中及术后门静脉化疗泵内局部化疗为可控因素。术中及术后门静脉化疗泵内局部化疗并配合全身化疗者预后明显好于未给予者（P=0.0076）。     

大肠癌伴肝转移同期切除的预后分析

目的分析大肠癌(结肠癌和直肠癌)伴肝转移行同期切除影响患者预后的相关因素。方法采用多因素回归分析方法回顾性分析3 7例大肠癌伴肝转移患者行同期切除的临床资料;选取11项相关因素进行分析。结果年龄,门静脉化疗泵内局部化疗,组织学分型,淋巴结转移,肝转移灶位置,大小,数目对患者的生存时间有影响。结论大肠癌伴肝转移行同期切除术中术后行门静脉化疗泵内局部化疗可以改善患者的预后,延长其生存期,并且后者是惟一可控因素。     

Risk factor stratification after simultaneous liver and colorectal resection for synchronous colorectal metastasis

Background/aim This study was conducted to devise a prognostic model for patients undergoing simultaneous liver and colorectal resection. Materials and methods A retrospective analysis was performed on 138 colorectal patients who underwent simultaneous liver and colorectal resection between September 1994 and September 2005. The primary endpoint of the study was overall survival. Three patients with positive liver resection margin were excluded from the analysis. Results At multivariate level, poor prognostic factors were liver resection margin ≤5 mm (P = 0.047; relative risk, 1.684; 95% CI = 1.010–2.809), CEA greater than 5 ng/ml (P = <0.001; relative risk, 2.507; 95% CI = 1.499–4.194), number of liver metastasis > 1 (P = <0.042; relative risk, 1.687; 95% CI = 1.020–2.789), and lymph node ≥ 4 (P = <0.012; relative risk, 1.968; 95% CI = 1.158–3.347). The risk stratification grouping of the 135 patients was performed according to the following criteria: low risk group, 0–1 factor; intermediate risk group, 2 factors; high-risk group, 3–4 factors. Of 135 patients, 86 patients (63.0%) were categorized as low-risk group, 36 patients (26.6%) as intermediate risk group, and 14 patients (10.4%) as high-risk group. Median survival times for low, intermediate, high-risk groups were 68.0, 43.6 (95% CI, 24.7–62.4), and 23.5 months (95% CI, 9.4–31.5), respectively. The high-risk group demonstrated an approximately threefold (relative risk, 3.1; 95% CI, 1.6–6.0) increased risk of death. Conclusions A simple risk factor stratification system was proposed to evaluate the chances of cure of patients after simultaneous resection of liver metastases and primary colorectal carcinoma. The risk factor stratification showed three groups with distinct survival. The risk stratification may help to predict patient survival after simultaneous liver and colorectal resection. This system needs further prospective validation.     

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。     

结直肠癌同时性肝转移行一期和二期肝切除术安全性的荟萃分析

目的 评估结直肠癌同时性肝转移患者一期和二期肝切除术的安全性.方法 通过检索PubMed/Medline,ISI Web of Knowledge,Springer link,Ebscohost,Elsevier Wiley Interscience和Google Scholar,搜集1989年1月至2009年3月关于结直肠癌同时性肝转移患者行一期和二期肝切除术的对照研究,对一期和二期手术组患者的手术并发症发生率和围手术期死亡率进行荟萃分析.结果 检索到7篇文献共计1390例结直肠癌同时性肝转移行肝切除术的患者,其中一期手术者495例,二期手术者895例.一期手术者围手术期死亡率（2.4%）高于二期手术者（1.1%）,差异有统计学意义（Peto OR 3.39,95% CI 1.29～8.93,P=0.01）;两组手术并发症发生率分别为33.9%和29.8%,两组比较差异无统计学意义[OR（随机）0.88,95% CI 0.51～1.51,P=0.64].结论 同时性结直肠癌肝转移患者有选择地行二期手术是合理和安全的.     

Simultaneous resection for rectal cancer with synchronous liver metastasis is a safe procedure

Background

One quarter of colorectal cancer patients will present with liver metastasis at the time of diagnosis. Recent studies have shown that simultaneous resections are safe and feasible for stage IV colon cancer. Limited data are available for simultaneous surgery in stage IV rectal cancer patients.

Methods

One hundred ninety-eight patients underwent surgical treatment for stage IV rectal cancer. In 145 (73%) patients, a simultaneous procedure was performed. Fifty-three (27%) patients underwent staged liver resection. A subpopulation of 69 (35%) patients underwent major liver resection (3 segments or more) and 30 (44%) patients with simultaneous surgery.

Results

The demographics of the 2 groups were similar. Complication rates were comparable for simultaneous or staged resections, even in the group subjected to major liver resection. Total hospital stay was significantly shorter for the simultaneously resected patients (P < .01).

Conclusions

Simultaneous resection of rectal primaries and liver metastases is a safe procedure in carefully selected patients at high-volume institutions, even if major liver resections are required.     

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.     

腹腔镜下结直肠癌肝转移一期手术23例临床疗效

目的探讨腹腔镜下治疗结直肠癌肝转移一期的安全性及有效性。方法回顾分析2011年1月至2013年6月行结直肠癌肝转移手术的43例患者的临床资料,将23例患者同时行腹腔镜切除肝转移灶切除术纳入腹腔镜组,20例患者同时行开放性肝转移灶切除术患者纳入开腹组。采用SPSS 23.0软件进行分析,中位生存时间、生存率及术后并发症比较采用χ2检验;计量资料采用(x珋±s)表示,比较采用独立样本t检验,生存分析采用Kaplain-Meire法计算生存率。P0.05表示差异有统计学意义。结果腹腔镜组患者手术时间及术后腹腔引流管留置时间较开腹组显著减少(P0.05);两组患者术中出血量、术后肛门排气时间及术后住院时间差异无统计学意义(P0.05);两组患者术后生存率相近,无围手术期死亡病例,术后均未见严重术后并发症。结论腹腔镜下结直肠癌肝转移一期联合切除安全可行,具有较好的疗效。     

Lung metastases--can resection also be justified in synchronous liver metastasis?

There is general agreement on the preconditions necessary for the resection of lung metastases: the primary tumor has to be resected completely, a local tumor recurrence as well as metastases in other organs have to be excluded. 5-year survival rate of patients operated under these criteria is said to be about 20 to 40% (number of own patients: 72; 5-year survival rate: 30.2%. Only in a few cases, however, lack of metastases in other organs is given. Often there are synchronic liver metastases. Local intraarterial chemotherapy doesn't put much burden on the patient, induces a decrease of liver metastases in 30% and a complete remission in a few cases, respectively. Between 1981 and 1987 we performed local chemotherapy of the liver in 575 patients. 110 patients showed lung metastases in the course of the treatment or during the aftercare period. In 8 patients we resected lung metastases occurring after remission of liver metastases. 7 patients died 11 to 28 months after the operation, 1 patient is still alive 16 months postoperatively.     

腹腔镜下结直肠癌及肝转移癌一期同时切除术的临床应用

目的：探讨腹腔镜下一期同时切除结直肠癌和肝转移癌的安全性及可行性。方法回顾性分析2011年1月至2013年10月期间在中山大学孙逸仙纪念医院完成的腹腔镜下结直肠癌和肝转移癌一期同时切除手术的11例患者的病例资料,对该术式的可行性（中转开腹率、手术时间及术中出血量）、安全性（术后并发症）及疗效（术后恢复、复发及生存情况）进行评估。结果全组11例患者手术均取得成功,无中转开腹病例。手术时间（284．6±28．8） min,术中出血量（322．7±75．4） ml,术后肛门排气时间（2．9±0．7） d,术后住院时间（12．3±1．9） d。全组患者术后未出现肠瘘、胆瘘、腹腔大出血、腹腔感染及肝功能衰竭等并发症。术后随访时间3～35月,除1例患者因肿瘤转移死亡外,其余病例未见肿瘤复发。结论对于经过选择的合适病例,腹腔镜下同时切除结直肠癌和肝转移癌是安全、可行的。     

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。     

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的手术疗效分析

目的探讨结直肠癌同时性肝转移的外科治疗临床价值和疗效。方法自2003年5月至2008年10月,对32例结直肠癌同时性肝转移患者行同期切除术为治疗组,同期内未行手术切除的肝转移瘤27例患者为对照组。两组术后以XELox方案化疗。结果治疗组1、3和5年累积生存率为92．5％、53．1％、34．6％。对照组1、3和5年生存率为66．7％、18．5％、0。两组总生存率比较有统计学意义（P〈0．05）。两组临床资料相比较无统计学意义（P〉0．05）。治疗组中有6例患者术后发生胸腔积液,1例膈下积液,3例胆漏,无手术死亡病例。结论结直肠癌肝转移的的根治性切除是患者获得长期生存的有效治疗手段;直肠癌同时性肝转移行同期切除术可提高患者的幸存时闻和幸存后量．改善其预后．     

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.