结直肠癌伴肝转移91例患者的多因素预后分析

目的：探讨结直肠癌同时性肝转移患者的预后相关因素。方法：采用多因素回归分析方法回顾性分析了91例结直肠癌同时性肝转移患者的生存因素。结果：91例结直肠癌同时性肝转移的患者中位生存期为16.8个月,1年生存率为61.54%,3年生存率为14.79%,5年生存率为8.87%。单因素分析显示原发灶手术、肝转移分期、介入治疗、放射治疗、物理治疗、化疗和新药使用与患者的生存期显著相关;多因素分析显示,肝转移分期、原发病灶手术切除、介入治疗、物理治疗对患者的预后有显著影响,是结直肠癌同时性肝转移影响预后的主要因素。结论：对于结直肠癌同时性肝转移的患者应积极切除原发病灶,进行介入、物理等综合治疗可以提高患者的生存期。     

结直肠癌同时性肝转移的预后因素分析

目的 探究结直肠癌同时性肝转移患者的临床病理特点,并分析影响其预后的相关因素,以期指导外科治疗决策.方法 回顾性分析中山大学附属第一医院自1994年8月至2009年12月收治的结直肠癌同时性肝转移患者231例,分析其预后与临床病理凶素的关系.结果 确诊时合并肝转移患者占同期结直肠癌患者总数的8.46%(231/2732).该组患者1、3、5年生存率分别为70.2%、21.9%,和11.4%,中位生存时间19个月.单因素分析显示:肿瘤周径(P=0.017)、浆膜侵犯(P=0.000)、肝转移分期(P=0.000)、浸润深度(P=0.010)、肿瘤分化程度(P=0.007)、手术方式(P=0.000)和化疗(P=0.041)影响患者预后.肝转移H1组患者1、3和5年生存率分别为88.4%、39.7%和21.3%,肝转移H2组分别为64.1%、15.7%和7.8%,肝转移H3组分别为55.0%、9.2%和0.0%(P<0.01).根治性手术组患者1、3和5年生存率分别为84.6%、37.9%和19.8%.姑息手术组分别为60.2%、24.0%和0.05%,减状手术或者未手术组1、3、5年生存率分别为37.0%、0.09%和0.0%(P<0.01).Cox回归模型多因素分析显示,只有肝转移分期(P=0.000)和手术方式(P=0.010)是结直肠癌肝转移患者的独立预后因素.结论 结直肠癌肝转移分期影响预后.应早期发现和诊治.对于结直肠癌仅有肝转移的患者应尽可能手术切除原发灶和肝转移病灶.化疗可以改善姑息术后患者的预后.     

结直肠癌同时性肝转移同期手术切除疗效分析

目的 分析结直肠癌同时性肝转移患者行同期手术切除原发灶和肝转移灶的近期及远期效果,探讨同期手术是否存在优势.方法 回顾性分析行手术治疗的53例结直肠癌同时性肝转移患者的临床资料,根据肝转移灶切除时间的不同,分为同期手术组(同期组)40例,分期手术组(分期组)13例,评价两组患者的手术效果.结果 同期组和分期组患者的手术时间分别为(212.9±72.3) min和(326.5±140.2)min,术中失血量分别为(337.5±298.0) ml和(594.6±430.5) ml,术后住院时间分别为(16.2±8.1)d和(25.8±8.5)d,差异均有统计学意义(均P＜0.05).同期组和分期组患者手术并发症的发生率分别为25.0％和53.8％ (P =0.053).两组均无手术死亡患者.同期组患者1、3、5年生存率分别为95.0％、57.0％和37.4％,中位生存时间为40.0个月,中位无病生存时间为14.0个月;分期组患者l、3、5年生存率分别为92.3％、58.7％和36.7％,中位生存时间为38.0个月,中位无病生存时间为13.0个月.两组患者生存时间差异无统计学意义(P＞0.05).结论 同期手术是治疗可切除的结直肠癌同时性肝转移患者安全、有效的措施,与分期手术比较,术中出血少,并发症发生率低,术后住院时间短.     

59例结直肠癌肝转移的外科治疗

背景与目的:结直肠癌(colorectalcancer,CRC)是最常见的恶性肿瘤之一,肝转移是结直肠癌治疗失败的最主要原因。结直肠癌肝转移若未经治疗,其中位生存期仅为6个月左右,手术切除是延长患者生存期的重要手段。本研究目的是探讨结直肠癌肝转移的外科治疗效果及影响预后的因素。方法:回顾性分析1987年1月～1998年12月行结直肠癌肝转移瘤切除59例患者资料。其中不规则性肝切除45例,规则性肝切除14例。术后发生并发症者4例(6.8%),未出现手术死亡。采用Kaplan鄄Meier法进行生存分析,log鄄rank检验进行统计学比较。应用Cox比例风险模型进行多因素分析。结果:全组总的1、3、5年生存率分别为91.4%、34.8%及21.9%。同时性肝转移患者的生存率显著高于异时性肝转移患者(P<0.01),肝转移瘤最大直径小于等于5.0cm患者的生存率高于大于5.0cm患者。肝转移发生时间与肿瘤最大直径大于5.0cm是影响预后的主要因素,而原发肿瘤淋巴结转移状况、术前癌胚抗原(CEA)水平及转移瘤数量对预后没有显著影响。结论:结直肠癌肝转移的外科治疗可使患者获得长期生存。通过加强随诊,早期发现肝转移瘤,可以提高手术切除率。     

结直肠癌肺转移和同时性肝转移生存分析

目的分析结直肠癌单纯性肺转移和结直肠癌肝转移(不包括肝、肺同时转移)患者的生存状况及影响因素。方法回顾性分析四川省肿瘤医院2011年11月至2018年6月收治的46例结直肠癌单纯性肺转移(其中同时性肺转移22例,异时性肺转移24例)和91例结直肠癌肝转移患者的临床资料、病理特征、治疗方法及预后生存情况,分析影响生存的相关因素,采用Cox回归模型分析影响单纯性结直肠癌肺/肝转移患者生存预后的相关因素。结果 46例结直肠癌肺转移患者的总体中位生存时间为58(6～104)个月,5年生存率为47.8%;其中手术组的中位生存时间和5年生存率显著优于化疗组(P0.01)。91例结直肠癌肝转移患者的总体中位生存时间为22(3～38)个月,3年生存率为33.3%,5年生存率为0%;其中手术组的中位生存时间和3年生存率显著优于其他组(P0.01)。Cox回归分析结果显示肝转移灶非手术及非局部治疗是影响患者预后的独立危险因素。结论结直肠癌同时性肺转移患者的生存期低于异时性肺转移。对于严格挑选的结直肠癌同时性肝或肺转移患者积极手术治疗可能改善其生存率。     

腹腔镜一期切除治疗直肠癌合并同时性肝转移

目的 总结腹腔镜一期切除治疗直肠癌合并肝转移患者的临床效果.方法 23例直肠癌合并同时性肝转移患者在行腹腔镜直肠癌切除的同时,行肝转移瘤切除,并与同期18例开腹一期切除直肠癌及肝转移瘤患者进行对比研究.全部患者术后均定期全身化疗.结果 所有患者均顺利行直肠癌切除和肝转移瘤切除,腹腔镜组无中转开腹,两组患者均无手术死亡.腹腔镜组和开腹手术组的手术时间分别为(350±45)min和(342±38)min(P>0.05),术中出血量分别为(275±96)ml和(590±85)ml(P<0.01),住院时间分别为(12±1.5)d和(16±2.5)d(P<0.05).腹腔镜组有1例患者手术中输血200 ml,而开腹手术组平均术中输血(500±100)ml(P<0.01).腹腔镜组患者的1、3、5生存率分别为82.6%、43.5%和8.6%,开腹手术组分别为77.8%、38.9%和0,差异无统计学意义(P>0.05).结论 腹腔镜一期切除直肠癌合并同时性肝转移癌安全可行,具有创伤小、恢复快的优点,患者的生存期与开腹一期切除相当.     

同时性结直肠癌肝转移患者治疗策略探讨

背景与目的:肝切除术是治疗同时性结直肠癌肝转移获得长期生存的希望.但如何选择肝切除术的手术时机,存在较大的争议,本研究探讨同时性结直肠癌肝转移的手术治疗策略.方法:选择上海东方肝胆外科医院和上海长海医院1995年1月至2005年12月收治的经手术治疗的83例同时性结直肠癌肝转移患者,其中37例行一期手术,46例行分期手术,比较两组手术并发症、死亡率、术中失血量、住院时间、生存率、中位生存期、无瘤生存期及肝转移癌复发率.结果:一期手术组手术并发症发生率为24.3%,分期手术组为19.6%(P=0.601).两组均没有手术死亡.一期手术组术中平均失血量为462 mL,分期手术组为574mL(P=0-312).一期手术组平均住院时间为19 d,分期手术组为36 d(P=0.001).一期手术组l、3、5年生存率分别为86.5%、54.1%和27.0%,分期手术组分别为89.1%(P-0.713)、52.2%(P=0.865)和23.9%(P=0.746).一期手术组中位生存期为40个月,分期手术组为37个月(丹0.075).一期手术组中位无瘤生存期为12个月,分期手术组为11个月(P=0.532).一期手术组肝转移癌复发率为35.1%,分期手术组为30.4% (P=0.650).结论:同时性结直肠癌肝转移患者有选择的一期手术切除原发病灶及肝转移病灶是合理的.     

伴有同时性肝转移结直肠癌的外科治疗

目的探讨伴有同时性肝转移结直肠癌的外科治疗及其适应证。方法收集经外科手术治疗的116例伴有同时性肝转移的结直肠癌患者的临床资料,进行生存分析,并通过单因素分析和Cox比例风险模型多因素分析确定患者预后的影响因素。结果116例患者均行结直肠癌原发肿瘤切除,18例行同期肝转移瘤切除。围手术期死亡2例(1.7%),术后发生并发症者17例(14.7%)。全组患者5年生存率为14.29%,肝转移瘤切除患者5年生存率为32.12%。多因素分析显示,肝转移瘤切除、腹腔扩散、介入治疗和全身化疗是影响预后的最主要因素。结论伴有同时性肝转移的结直肠癌患者,选择外科手术切除肿瘤病灶,并辅助综合治疗可延长患者的生存时间。     

144例结直肠癌肝转移原发灶切除术后临床病理特征和预后分析

目的:分析144例结直肠癌肝转移原发灶切除术后患者的临床病理特征和预后。方法:回顾性分析病理证实的144例结直肠癌肝转移原发灶切除术后患者的临床病理特征和预后,Kaplan-Meier法分析生存率,Log-rank检验比较组间生存差异。结果:144例结直肠癌肝转移组及其中77例结直肠癌同时性肝转移亚组的中位生存期分别为28个月和21个月,所有病例分析显示原发肿瘤分化程度、肝转移发生时间、肝转移灶数目及治疗方法与预后显著相关(P＜0.05);同时性肝转移亚组分析显示原发肿瘤分化程度、性别、TNM分期与预后显著相关(P＜0.05);两组病例分析显示年龄对患者总生存期的影响无统计学差异(P＞0.05)。结论:原发肿瘤低分化、同时性肝转移、多发肝转移及单纯化疗是结直肠癌肝转移原发灶术后患者独立预后不良因素。原发肿瘤低分化、男性及Ⅱ-Ⅲ期是结直肠癌同时性肝转移原发灶术后患者独立预后不良因素。年龄对结直肠癌肝转移原发灶切除术后患者总生存期的影响无统计学意义。     

结直肠癌肺转移和同时性肝转移生存分析

目的分析结直肠癌单纯性肺转移和结直肠癌肝转移(不包括肝、肺同时转移)患者的生存状况及影响因素。方法回顾性分析四川省肿瘤医院2011年11月至2018年6月收治的46例结直肠癌单纯性肺转移(其中同时性肺转移22例,异时性肺转移24例)和91例结直肠癌肝转移患者的临床资料、病理特征、治疗方法及预后生存情况,分析影响生存的相关因素,采用Cox回归模型分析影响单纯性结直肠癌肺／肝转移患者生存预后的相关因素。结果46例结直肠癌肺转移患者的总体中位生存时间为58(6～104)个月,5年生存率为478％;其中手术组的中位生存时间和5年生存率显著优于化疗组(P<001)。91例结直肠癌肝转移患者的总体中位生存时间为22(3～38)个月,3年生存率为333％,5年生存率为0％;其中手术组的中位生存时间和3年生存率显著优于其他组(P<001)。Cox回归分析结果显示肝转移灶非手术及非局部治疗是影响患者预后的独立危险因素。结论结直肠癌同时性肺转移患者的生存期低于异时性肺转移。对于严格挑选的结直肠癌同时性肝或肺转移患者积极手术治疗可能改善其生存率。     

Strategies for the treatment of synchronous liver metastasis.

AIM: Observe the outcomes after complete simultaneous or delayed resection of synchronous liver metastasis (SLM) from colorectal cancer (CRC). METHODS: From 1994 to 2005, 119 patients were diagnosed with CRC and SLM; 57 patients had simultaneous resection (group I) and 62 patients had staged resection (group II). Perioperative chemotherapy was considered completed if all expected cycle were administrated. RESULTS: Overall survival rates of group I-group II at 1, 3 and 5 years were respectively 91%-93% (p=0,3), 59%-57% (p=0,09) and 32%-25% (p=0,06). The median survival time of group I-group II were respectively 46 months-40 months (p=0,07). There was no statistical difference on survival regarding location of metastasis (p=0,09) or primary tumor location (p=0,2). Patients with simultaneous or staged resection receiving optimal treatment (R0 liver surgery and complete chemotherapy) were respectively 89% and 67% (p=0,04). Twenty three patients developed isolated liver recurrence with higher frequency in staged patients (26% vs 9% p=0,03) without impairment of survival. CONCLUSIONS: Because of postoperative morbidity and prolonged tiring treatment, many patients having staged resection were under treated. However we did not observe statistical difference on survival but we supported that simultaneous resection has to be prefer to achieve an optimal treatment. Lung and bone metastasis are the new challenge for oncologists.     

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。     

结直肠癌肝转移患者预后因素分析

目的：探讨结直肠癌肝转移患者外科治疗后的预后影响因素及临床意义.方法：分析本院1995年1月至2000年12月158例经病理证实、随诊资料完整的结直肠癌肝转移病例临床资料，对影响患者生存的12项因素进行单因素、多因素分析.结果：根治性切除67例（42.4%）、姑息性切除53例（33.5%）、探查术或最佳支持治疗38例（24.1%） 术后化疗82例（51.9%）、术后未化疗76例（48.1%） 切缘阴性132例（83.5%）、切缘阳性26例（16.5%） 中位生存期41个月，5年生存率27.0%.单因素分析表明，外科治疗方式（P=0.013＜0.05）、原发瘤N分期（P=0.003＜0.05）、转移灶大小（P=0.037＜0.05）及分布（P=0.032＜0.05）和切缘（P=0.000＜0.001）、辅助性治疗（P=0.041＜0.05）为预后影响因素 多因素回归分析显示，仅有原发瘤N分期（P=0.004＜0.05）为预后的独立影响因素，淋巴结转移的相对危险度为2.086.结论：结直肠癌肝转移的根治性切除是患者获得长期生存的有效治疗手段 对于结直肠癌肝转移患者应恰当选择病例，力求一期根治性切除 不适合一期根治性切除者，应采用新辅助化疗手段，降级肿瘤的临床病理分期，以期提高根治性切除率，提高患者生存期.     

原发性肝癌姑息切除术后插管化疗的临床研究

本文对38例原发性肝癌姑息性切除术后,经肝动脉、门静脉插管化疗与38例相同病期仅作姑息性切除的肝癌患者进行配对分析,结果显示插管化疗组AFP转阴率及术后1年生存率均显著高于未插管组,分别为84.8％与 61.3％,55.3％与21.1％(P<0.05).而AFP术后3个月转阳率插管组低于未插管组,分别为50％与74.5％(P<0.05).提示对无法行根除性切除的肝癌患者,在作姑息切除术的同时,行肝动脉、门静脉插管化疗,对提高术后生存率有确切疗效.     

肝脏部分切除术在复发性上皮性卵巢癌肝实质转移治疗中的价值

目的 探讨复发性上皮性卵巢癌肝实质转移患者行肝脏部分切除术的临床价值.方法 回顾性分析39例复发性上皮性卵巢癌肝实质转移患者的临床病理资料.结果 39例患者中,10例进行了肝脏部分切除术,29例仅行挽救性化疗.手术组患者的病变均为单叶,且病灶＜3个,与化疗组比较,差异有统计学意义(P＜0.05),在年龄、初次手术病理类型及病理分级、初次减瘤手术结果、初次治疗后的无瘤生存时间、肝转移瘤大小及肝转移时CA125水平等方面,差异均无统计学意义(P＞0.05).10例手术患者中,单纯行肝脏手术6例,同时行其他部位肿瘤细胞减灭术4例,其中7例减瘤手术满意.3例发生手术并发症,无手术死亡病例.8例肝脏病理切缘为阴性的患者中,局部复发6例,中位复发时间为术后12个月.减瘤手术满意的患者与行挽救性化疗的患者,肝转移后的中位总生存时间分别为26个月和9个月,肝转移后3年累积生存率分别为60.0%和16.8%,两组比较,差异有统计学意义(P＜0.05).结论 对存在肝实质转移的复发性上皮性卵巢癌患者施行包括肝脏部分切除术在内的满意肿瘤细胞减灭术,术后辅以化疗,有可能改善患者的预后.

Abstract：

Objective To investigate the validity of hepatic resection as a treatment option for hepatic parenchymal metastasis in patients with recurrent epithelial ovarian cancer. Methods A retrospective review of the clinicopathological and follow up data of 39 patients treated in our hospital from 1996 to 2008was conducted. Results Ten patients underwent partial hepatic resection for metastatic ovarian cancer.All the 10 patients underwent surgery were with unilobar metastasis and the number of tumors was lower than 3 (P ＜0.05).No significant difference existed in patient age,the primary pathology type and tumor grade,the rate of optimal primary cytoreductive surgery,the disease free survival after the primary therapy and the serum CA125 level at the liver metastasis when compared with the 29 patients accepted salvage chemotherapy(P ＞0.05).There were 7 patients who achieved optional surgery.The operation complication was 3/10 andthere was no perioperative mortality.There were 2 patients without postoperative chemotherapy in the 8 recurrent patients with microscopic negative margins.The median recurrence time was 12(5-24) months after the hepatic resection.The overall median survival periods after hepatic metastasis were 26 and 9 months and the 3-years cumulative survival rates were 60.0% and 16.8% for the optimal surgery patients including hepatic surgery and the salvage chemotherapy patients,respectively(P ＜0.05).Conclusion Hepatic resection for liver metastatic epithelial ovarian cancer is safe and may achieve long-term survival in patients after optimal second cytoreductive surgery.     

Is resection of periampullary or pancreatic adenocarcinoma with synchronous hepatic metastasis justified?

BACKGROUND: To date, no consensus has been reached regarding which primary tumor subtypes are managed appropriately with hepatic metastectomy. Specifically, the role of hepatic resection for metastatic periampullary or pancreatic adenocarcinoma remains controversial. METHODS: Between 1995 and 2005, 1563 patients underwent surgical resection for periampullary carcinoma (n=608 patients) or pancreatic adenocarcinoma (head, n=905 patients; tail, n=50 patients). Data on demographics, operative details, primary tumor status, and-when indicated-extent of hepatic metastasis were collected. RESULTS: Of the 1563 patients who underwent resection of periampullary or pancreatic adenocarcinoma, 22 patients (1.4%) underwent simultaneous hepatic resection for synchronous liver metastasis. The primary tumor site was ampullary (n=1 patient ), duodenal (n=2 patients), distal bile duct (n=2 patients), or pancreas (head, n=10 patients; tail, n=7 patients). The majority of patients (86.4%) had a solitary hepatic metastasis, and the median size of the largest lesion was 0.6 cm. Hepatic metastectomy included wedge resection (n=20 patients), segmentectomy (n=1 patient), and hemihepatectomy (n=1 patient). After matching patients on primary tumor histology and location, the median survival of patients who underwent hepatic resection of synchronous metastasis was 5.9 months compared with 5.6 months for patients who underwent palliative bypass alone (P=.46) and 14.2 months for patients with no metastatic disease who underwent primary tumor resection only (P<.001). Pancreatic (median, 5.9 months) versus nonpancreatic (median, 9.9 months) primary tumor histology was not associated with a difference in survival in patients who underwent resection of synchronous liver metastasis (P=.43). CONCLUSIONS: Even in well selected patients with low-volume metastatic liver disease, simultaneous resection of periampullary or pancreatic carcinoma with synchronous liver metastases did not result in long-term survival in the overwhelming majority of patients.     

Combined-modality treatment for resectable metastatic colorectal carcinoma to the liver: surgical resection of hepatic metastases in combination with continuous infusion of chemotherapy--an intergroup study.

PURPOSE: Despite technical improvements that have minimized the morbidity and mortality of hepatic surgery, the long-term outcome of resection of hepatic metastases of colorectal cancer remains poor, with the majority of patients experiencing treatment failure in the liver. Because arterial chemotherapy regimens targeted to the liver have demonstrated high response rates, an intergroup trial of adjuvant therapy for patients undergoing hepatic resection of liver metastases from colorectal cancer was initiated. PATIENTS AND METHODS: Patients with one to three potentially resectable metastases were randomized preoperatively to receive no further therapy (control arm, 56 patients) or postoperative hepatic arterial floxuridine combined with intravenous continuous-infusion fluorouracil (chemotherapy arm, 53 patients). After exclusion of patients identified as ineligible for the planned treatment at the time of surgery, there were 45 control patients and 30 on the chemotherapy arm. The study was powered to evaluate improvement in time to recurrence and hepatic disease-free survival, not overall survival. RESULTS: The 4-year recurrence-free rate was 25% for the control arm and 46% for the chemotherapy group (P =.04). The 4-year liver recurrence-free rate was 43% in the control group and 67% in the chemotherapy group (P =.03). The median survival of the 75 assessable patients was 49 months for the control arm and 63.7 months for the chemotherapy arm (P =.60). The median survival of all 109 patients was 47 months for the control arm compared with 34 months for the chemotherapy arm (P =.19) CONCLUSION: These data demonstrate that adjuvant intra-arterial and intravenous chemotherapy was beneficial in prolonging time to recurrence and pre-venting hepatic recurrence after hepatic resection of colorectal cancer.     

Pulmonary resection of colorectal metastases in patients with or without a history of hepatic metastases

Introduction

In selected patients with isolated colorectal lung or liver metastases resection can provide an increase in overall survival and even cure. Here, we evaluate whether also patients with combined or sequential metastatic disease to liver and lung may still be candidates for surgical resection.

Methods

From 1997 till 2006 39 patients underwent pulmonary metastasectomy. Two subgroups were identified: resection of pulmonary metastases only (PM) and resection of hepatic and later pulmonary metastases (LPM).

Results

Patient characteristics were identical in both groups. Median follow-up in group PM was 35 months and 38 months in group LPM. Two-year survival in group PM was 61%, and in group LPM 81% (p = NS). Five-year survival was 30% and 20% in PM and LPM groups, respectively (p = NS). The median disease free survival was 12 months in the PM group and 13 months in the LPM group.The extent of pulmonary resection had no impact on survival. Complications occurred in seven patients in the PM group and two patients in the LPM group. Complication rate and severity were related to the extent of pulmonary resection. A small group of patients underwent repeated pulmonary resection without serious complications.

Conclusion

Resection of pulmonary colorectal metastases may improve survival, even in patients who underwent hepatic resection for colorectal liver metastases at an earlier stage.     

直肠癌同时性肝转移同期切除与分期切除比较*

目的:比较直肠癌同时性肝转移患者同期切除与分期切除安全性及远期疗效。方法:收集从2000年1 月至2015年4月北京大学肿瘤医院行手术切除的54例直肠癌同时性肝转移患者的临床病理及围手术期资料,并随访其复发及生存状况,比较同期切除组（19例）及分期切除组（35例）的安全性及远期疗效。结果:两组患者临床病理资料基本一致。同期切除组及分期切除组术后Clavien-Dindo 1 级、2 级、3 级及4 级并发症的发生率分别为10.5%（2/ 19）、31.6%（6/ 19）、5.3%（1/ 19）及10.5%（2/ 19）和8.6%（3/ 35）、17.1%（6/ 35）、25.7%（9/ 35）及0（0/ 35）;差异无统计学意义（P = 0.093）。 但术后中位住院时间同期组明显低于分期组（同期组14d,分期组25d,P < 0.001）。 同期组与分期组术后中位生存期差异无统计学意义（同期组未达到,分期组39个月,P = 0.649）,两组术后无病生存期差异无统计学意义（同期组10个月,分期组10个月,P = 0.827）。 结论:直肠癌同时性肝转移患者同期切除与分期切除比较未明显增加患者围手术期并发症,而且远期疗效相似。