原发性肝癌术后肝内复发与肝外转移再手术切除疗效分析

[目的]探讨原发性肝癌术后肝内复发与肝外转移再手术切除的疗效.[方法]回顾性分析267例再切除的复发性肝癌患者的临床资料,其中205例行再次肝切除,51例行肝外转移癌切除,11例行肝内复发和肝外转移癌联合切除,比较其临床病理特征和生存率.[结果]肝内复发组第二次手术后1年,3年,5年和10年生存率为81.7%,42.2%,20.0%和10.0%,第三次手术后为78.3%,30.4%,13.0%和8.7%.中位生存时间为44个月.肝外转移组第二次手术后为80.4%,32.0%,16.0%和4.3%,第三次手术后为76.0%,27.9%,13.6%和0.中位生存时间为43个月.肝内复发联合肝外转移切除组总的1年,3年,5年和10年生存率为100.0%,72.7%,36.4%和0.肝内复发组与肝外转移组再切除术后生存率的比较差异无显著性(P＞0.05).[结论]再手术切除不仅适用于肝内复发,还可有选择适用于肝外转移.肝外转移再切除也能延长生存期.     

原发性肝癌术后复发246例再治疗的近期疗效

目的探讨不同治疗方法对复发性肝癌患者治疗效果的影响。方法回顾性分析我院246例复发性肝癌患者的临床资料,38例行再次切除术,其中复发性肝癌单纯根治性手术切除18例;复发．性肝癌手术切除联合综合治疗20例;经皮肝动脉插管栓塞化疗（TACE）62例;146例患者给予保守治疗。结果1、3,5年生存率手术切除组分别为76．3％、394％及25．8％;TACE治疗组分别为53．2％、19.6%及9．3％;保守治疗组分别为37．7％、8．0％及1．5％,手术切除组与TACE治疗组及保守治疗组的生存率差异有统计学意义（P均〈0．05）。结论复发性肝癌二次手术切除治疗仍为首选方法,手术切除联合综合治疗是目前复发性肝癌再治疗的理想治疗模式,对患者的无瘤生存率及生存率均有所提高,并降低肝内再次复发,延长患者生存时间。     

复发性肝癌的再手术治疗

复发性肝癌的再手术治疗顾红光，蔡景修，余枢成第三军医大学西南医院肝胆外科中心（６３００３８）原发性肝细胞癌行肝切除术后远期疗效并不令人满意，五年生存率低于３０％，多数死于肝内肿瘤复发。因此肝癌术后预防和治疗肝内夏发是进一步提高手术效果的重要课题。我院...     

小肝癌切除术后复发的监测及复发病灶再治疗的价值

本文对８２例手术切除的小肝癌进行了分析，探讨小肝癌术后复发的规律、监测方法和复发病灶再次治疗的价值。结果提示，本组术后１～５年累计复发率分别为３０．５％、４２．７％、４５．１％、５０．０％和５１．２％。其中，术后３年内为复发的高发期，术后３年内复发人数占总复发人数的８６．１％。首次手术采用根治性切除可以降低复发率。术后定期复查有利于发现亚临床复发病灶，为再次治疗提供有利条件。本组４３例复发病例中，再次肝切除１８例，行经皮肝动脉栓塞化疗术４例，Ｂ超引导下无水酒精注射１例。复发病灶的再治疗可明显提高术后生存率。其中，复发病灶的再切除是提高小肝癌术后生存率的最主要途径，可使术后生存率提高３０％左右。     

影响小肝癌术后复发的因素及再次手术的意义

采用ＣＯＸ模型对７２例小肝癌切除术后复发情况进行分析，筛选出影响术后复发的显著因素为：肿瘤包膜、术后ＡＦＰ变化、癌周淋巴细胞量。手术方式和切缘与肿瘤距离。结果提示，术后１、３、５年复发车分别为３０．５％，４４．４％和５１．４％，术后３年为复发高危期。首次手术采用根治性切除可降低术后复发率。复发癌的再次手术切除是提高术后生存率的重要途径，对不能再次手术者，经皮肝动脉栓塞化疗术和Ｂ超引导下无水酒精注射术也有良好疗效。     

原发性肝癌肝切除术肝动脉与门静脉灌注化疗的比较

目的评价原发性肝癌根治性切除术后肝动脉灌注化疗与门静脉灌注化疗的疗效，探讨原发性肝癌根治性切除术后复发及转移的预防途径。方法经病理确诊的原发性肝癌７５例，其中４２例行根治性切除及术后选择性肝动脉插管化疗，３３例行根治性切除及术后门静脉灌注化疗。每隔１～３个月重复，定期复查。结果原发性肝癌切除术后肝动脉灌注化疗组的术后复发率（２１．４３％）低于门静脉灌注化疗组（３６．３６％），且生存时间（１１．４个月）明显较门静脉灌注化疗组（７．６个月）长，而门静脉灌注化疗组的转移率（９．０９％）明显低于肝动脉灌注化疗组（３２．１４％）。结论原发性肝癌根治性切除术后行肝动脉灌注化疗较门静脉灌注化疗疗效好，而原发性肝癌切除术后同时结合肝动脉、门静脉灌注化疗对术后预防肿瘤的复发与转移可能更为理想     

原发性肝癌术后复发的再次切除—附32例分析

目的；探讨肝细胞癌切除后复发的相关因素及合理治理方法。方法：1996年8月至1999年8月对32例肝癌切除后复发的患者进行再次肝切除手术。结果：手术后1年、2年、3年的生存率分别为84．4％（27／32）、68．8（22／32）、40．1％（13／32）。结论：复发后再次肝切除可获得良好的疗效。     

复发性胃癌再次手术的临床意义

[目的]探讨复发性胃癌再次行外科手术治疗的意义。[方法]回顾性分析1990年1月~2005年12月收治的103例复发性胃癌的临床资料。[结果]103例胃癌,复发局限于残胃45例,首次术后2年内复发61例。全组再手术切除54例,其中根治性切除43例,姑息性残胃切除11例,合并联合脏器切除25例。全组再次手术后1、3、5年生存率分别为71.2%、21.6%和9.5%,其中根治性残胃切除术后1、3、5年生存率分别为86.2%、49.1%和19.5%,中位生存期32.0个月;姑息性切除术后1、3、5年生存率分别为45.5%、10.0%和0,中位生存期15.0个月;未切除患者均于1年内死亡。[结论]残胃局部复发癌以残胃、吻合口局部复发及邻近器官浸润为主,具有较高的切除率,应积极行再手术治疗。     

600例肝切除术治疗肝癌的效果

１９６４～１９９３年间共行肝癌切除术６００例，其中２４例为肝癌切除术后复发再次行肝切除术。男５３３例，女６７例。年龄８～７８岁，以４０～５９岁者居多。ＡＦＰ阳性率为５７．４％，合并肝硬化占８４．４％。肝细胞癌占９１．６％。肿瘤直径＜５ｃｍ者１３０例，占２１．７％。６００例中，施行规则性肝切除１０例，非规则性肝切除５９０例，包括２４例再次肝切除术。本组有２９例为肝癌自发性破裂出血后作肝切除术，其中２４例即时手术，５例作肿瘤破裂填塞止血后１６～４１天后再行肝切除术。此外，有１３例术前作ＴＡＥ后再行肝切除术，６例经剖腹探查证实不能切除后，采用多模式治疗，待肿瘤缩小后再作肝切除术。本组术后死亡２４例，手术死亡率为４．０％。死因多为肝功能衰竭和上消化道大出血。本组术后的１、３、５、１０年生存率分别为６１．９％、４０．０％、３３．０％和２９．２％。肿瘤直径≤５ｃｍ的１、３、５、１０年生存率分别为８７．８％、６９．４％、５４．０％和４３．０％。     

复发肝癌再手术治疗的体会

目的:探索肝癌术后复发患者再次手术治疗的可行性、安全性及治疗效果。方法:回顾性分析2010年至2016年于我院行手术切除的原发性肝癌术后复发患者的临床资料。结果:共有37例肝癌术后复发患者行再次手术治疗,所有患者均无手术期死亡,术后并发症发生率为32.4%。中位生存期为20个月,1、3和5年生存率分别为83.8%、36.4%和5.6%。结论:对于具有根治性手术切除的复发性肝癌患者,再手术是安全有效的。     

An analysis of prospective outcome of re-resection for recurrent liver cancer and extrahepatic metastases,a follow-up of 267 cases

Objective To evaluate the prospective outcome and summarize experience in re-resection for recurrent liver cancer and extrahepatic metastases. Methods The clinical data of 267 patients with recurrent primary liver cancer (PLC) after re-resection from January 1960 to July 2000 were retrospectively analyzed. Re-hepatectomy was performed on 205 cases, resection of extrahepatic metastases on 51 cases and combined resection of recurrent liver cancer and extrahepatic metastases on 11 cases. The clinico-pathologic features, operation type and survival were compared. Results The types of liver re-resection included left lateral lobectomy in 11.2% of patients, hemihepatetomy and extended hemi-hepatectomy in 4.4%, local radical resection in 68.3%, other subsegmentectomy in 17.1%. The peak recurrence rate (64.4%) occurred at 1–2 years. The overall 1-, 3, 5- and 10-year survival rates after second resection were 81.0%, 40.3%, 19.4% and 9.0% respectively, while they were 77.5%, 29.8%, 13.2% and 6.61% respectively after the third resection. The median survival time was 44 months. The re-resection with extrahepatic metastases also provided the possibility of longer survival. Conclusion The results suggest that subsegmentectomy and local excision is appropriate for the hepatic repeat resection. The peak recurrence may be correlated with portal thrombus and operative factor. The re-resection can be indicated not only in intrahepatic recurrent metastases but also in extrahepatic metastases in selected patients. Re-resection has become the treatment of choice for recurrence of PLC, as neither chemotherapy nor other nonsurgical therapies can achieve such favorable results.     

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.     

Value of follow-up in the management of recurrent colorectal cancer

The purpose of this article was to study the effectiveness of a prospective follow-up programme in patients after curative surgery for colorectal cancer. Of the initial 151 selected patients, 61 (40%) developed a recurrence in whom only six cases (10%) of potentially curable recurrent lesions were detected. The first clues to recurrence in the 61 patients were history or physical examination in 49%, a rising CEA in 29% and a positive imaging finding in 10%, being difficult to decide which test first signalled a recurrent cancer in an additional 11%. Endoscopy and CEA determinations were the most rewarding investigations. CEA was a sensitive means of identifying disseminated recurrent disease and liver metastases compared with liver function tests or liver ultrasound every 3 months. Endoscopy was useful in the diagnosis of local recurrences. However no follow-up test was capable of detecting recurrent colorectal cancer when it might still have been curable. As a direct result of this follow-up programme 15 patients (23%) underwent re-exploration. No symptomatic patients were candidates for curative re-operation. Of the asymptomatic patients six (four colonic and two rectal cancers) (19.5%) were re-resected for cure. Only three of these were alive and without evidence of disease, 40, 43 and 69 months later so that long term survivors after curative re-resection represent only 5% of all patients with recurrences (7.2% of the recurrent colonic cancer and 3% of the rectal cancer). Our follow-up programme did not permit us to alter the incidence of disseminated recurrent disease, and the effectiveness of the curative re-resection represents an increase of only 1.3% in the global 5-year survival rates for colorectal cancer. Our study does not demonstrate any great value of 'classical' postoperative follow-up programme.     

Recurrent hepatocellular carcinoma after hepatic resection: prognostic factors and long-term outcome.

AIM: The prognosis of patients with recurrent hepatocellular carcinoma (HCC) after hepatic resection varies widely. This study analyzed long-term survival and prognostic factors of patients with recurrent HCC after hepatectomy. METHODS: From July 1991 to December 2000, 623 patients underwent hepatic resection for HCC. Of those, 347 (56.5%) patients had tumour recurrence, and 286 patients with follow-up time more than 24 months after recurrence were enrolled. Twenty-seven clinicopathologic factors underwent both univariate and multivariate analysis. RESULTS: Of these 286 patients, survival times after tumour recurrence were mean 672+/-619 days; median 468 days; and, range 10-3753 days. The overall 1-, 3-, 5-, and 10-year post-recurrence survival rates were 61.5, 33.4, 18.2, and 9.0%, respectively. Seventy (24.5%) patients were alive at the time of study, and 10 of the 34 patients who underwent re-resection were disease-free. By Cox regression analysis, multiple initial tumours (relative risk (RR) 1.428), recurrent multiple (RR 1.372), extrahepatic recurrence (RR 2.434), recurrent tumour size >2 cm (RR 1.926), post-hepatectomy period until recurrence <1 year (RR 1.769), and non-resectional treatment of recurrent tumours (RR 3.527) were independent prognostic factors for post-recurrent survival rates. CONCLUSIONS: In patients with recurrent HCC after hepatectomy, both initial and recurrent tumour factors influenced their prognosis. Early detection of recurrent tumours is important. Re-resection correlated with better post-recurrent survival rates.     

Tumor recurrence and options for further treatment after resection of liver metastases in patients with colorectal cancer

The aim of this study was to evaluate the pattern of recurrence and its impact on therapy in patients undergoing liver resection for colorectal metastases. Within 7 years 105 patients were operated on; 75 patients were followed up for at least 2 years postoperatively with a median follow-up of 30 months (range 24-93 months). The median time interval when patients were free of tumor recurrence was only 9 months. The initial recurrence site was the liver in 47% and the other sites were extrahepatic in 39%. Seventy-one percent of the patients developed disseminated metastases as the disease progressed. The median survival time after diagnosis of tumor recurrence was 14 months and was significantly affected by the type of treatment used for the recurrence. Surgical resection was followed by a 23-month median survival, while systemic and intra-arterial chemotherapy led to a 14- and 15-month median survival time, respectively. Untreated patients had a median survival of only 4 months. It is concluded that liver resection for colorectal secondaries leads to a very limited number of disease-free survivors after 5 years. As a few patients may profit from a surgical treatment even in cases of recurrence, surgery should not be regarded as useless.     

复发转移性结直肠癌的外科治疗及预后分析

背景与目的:结直肠癌是常见恶性肿瘤之一,其发病率有逐渐增高的趋势.其主要的治疗方法是根治性手术,手术后的复发及转移是导致患者死亡的主要原因.目前复发性结直肠癌的再手术是提高患者生存率和生存质量的主要方法.本文探讨结直肠癌术后复发的原因、诊断和外科治疗方法.方法:回顾性分析2003-2006年35例复发与转移性结直肠癌的外科治疗及预后.结果:手术后1年内复发者9例 (26%),3年内复发者26例(74 %).本组35例复发或转移性结直肠癌均行再次手术,7例复发性直肠癌再切除4例,造瘘3例,28例复发性结肠癌中,根治性切除8例(包括5例肝转移灶切除),姑息性切除10例,盲肠或横结肠造瘘10例.总切除率为63 %(22/35),其中根治性切除率为55%(12/22),姑息性切除45%(10/22).术后随访6～36个月,2例失访,12例根治性切除组中,9例无瘤生存,1例肺转移,2例肝转移;23例姑息治疗组中,5例死亡,4例肝转移,其余14例带瘤生存.结论:结肠癌的手术治疗,应根据其生物学特点,采取规范的手术方式、彻底清除原发灶、转移的肠系膜及淋巴结,术中注意无瘤操作,术后酌情辅以化疗或放疗,定期随访,是预防结直肠癌术后复发的主要措施.而对复发和转移病例,应根据其部位、临床特征,选择以手术为主的综合治疗方案,酌情达到根治或姑息治疗的目的.     

Incidence of recurrence after hepatic resection and prophylactic hepatic arterial infusion chemotherapy for liver metastases from colon cancer

We studied recurrence after hepatic resection and prophylactic hepatic arterial infusion chemotherapy for liver metastases from colon cancer, retrospectively. Eighty-six patients underwent curative hepatic resection for liver metastases, and 41 of them received arterial infusion chemotherapy. Eight patients (20%) developed only remnant liver metastases, 6 patients (15%) had hepatic and extrahepatic recurrences, and 10 patients (24%) developed only extrahepatic recurrences. Regional therapy including hepatic resection for residual liver metastases should be indicated for recurrences after hepatic arterial infusion chemotherapy.     

Curative liver resection for metastatic breast cancer.

AIMS: Hepatic resection is a standard procedure in the treatment of colorectal liver metastases. Liver metastases are frequent in breast cancer, but resectional treatment is rarely possible and few reports have addressed the results of surgical treatment for metastatic breast cancer. The aim of our study was to analyse the outcome of patients with metastatic breast cancer after resection of isolated hepatic secondaries and possibly to identify selection criteria for patients who may benefit from surgery. METHODS: Between 1984 and 1998, 90 patients with a history of breast cancer and suspected liver metastases were referred for surgical evaluation. Fifty-four patients also had extrahepatic disease or metastases from another primary tumour; multiple liver metastases were not amenable to surgical treatment in 20 patients. Five patients were treated by regional chemotherapy via an intra-arterial port catheter; after liver resection two patients were found to have liver metastases from intercurrent colorectal cancer. Thus only nine liver resections for metastatic breast cancer could be performed with curative intent. RESULTS: No patient died post-operatively after liver resection. In the follow-up period, four of the nine patients who were treated with curative intent received systemic chemotherapy. At a median follow-up of 29 months, four patients died from tumour recurrence. Five patients are currently alive. Five-year survival in the resection group was calculated as 51% (Kaplan-Meier estimate). Node-negative primary breast cancer and a long interval between treatment of the primary and liver metastases appeared to be associated with long survival after liver resection. CONCLUSIONS: These observations suggest that careful follow-up and adequate patient selection could offer some patients with isolated liver metastases from breast cancer a chance of long-term survival.     

Resected pancreatic ductal adenocarcinomas with recurrence limited in lung have a significantly better prognosis than those with other recurrence patterns

The majority of patients with curative resection of pancreatic ductal adenocarcinoma recur within 5 years of resection. However, the prognosis associated with different patterns of recurrence has not been well studied. A retrospective review of patients who underwent curative surgical resection of pancreatic cancer was performed. Of the 209 patients, 174 patients developed recurrent disease. Of these 174, 28(16.1%) had recurrent disease limited to lung metastases, 20(11.5%) had recurrence in the lung plus one or more other sites excluding the liver, 73(42.0%) had liver metastasis alone or liver metastasis with any other site except lung, 28(16.1%) local recurrence only, and 25(14.3%) peritoneal recurrence alone or together with local recurrence. Patients with recurrence limited to lung had a 8.5 months(Mo) median survival from recurrence to death, which was significantly better than the survival associated with recurrence in the liver(5.1Mo), in the peritoneum(2.3Mo) or locally(5.1Mo) in multivariable analyses. Among all groups, the time from surgery to the diagnosis of recurrence in patients who recurred in only in the lung was also the longest. However, 75% of patients were found to have indeterminate lung nodules on their surveillance CT scans prior to the diagnosis of recurrence in lung. This delayed diagnosis of lung recurrence may have a negative impact on survival after recurrence. In conclusion, pancreatic cancer with lung recurrence has a significantly better prognosis than recurrence in other sites. Further studies are needed to investigate how different diagnostic and treatment modalities affect the survival of this unique subpopulation of pancreatic cancer patients.