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。

Surgical treatment for liver metastasis of colorectal cancer: a report of 59 cases

BACKGROUND & OBJECTIVE: Liver metastasis is the major cause of treatment failure of colorectal cancer. The median survival time of patients with untreated liver metastases is only about 6 months. Surgical resection is the major treatment to prolong survival time of the patients. This study was to assess surgical treatment efficacy on these patients and their prognosis. METHODS: Records of 59 colorectal cancer patients with liver metastases, treated with hepatectomy (including 14 cases of anatomical segmentectomy and 45 cases of wedge resection) from Jan. 1987 to Dec. 1998 in Cancer Hospital of Chinese Academy of Medical Sciences were reviewed. Postoperative complications occurred in 4 (6.8%) patients, without surgical death. Survival rate was estimated by Kaplan-Meier method, and compared by log-rank test. Prognostic factors were analyzed by multivariate Cox regression model. RESULTS: The overall 1-, 3-, and 5-year survival rates were 91.4%, 34.8%, and 21.9%. Survival rate was significantly lower in patients with heterochronia metastasis than in patients with synchronal metastasis (P < 0.05), and lower in patients with metastasis size of > 5 cm than in patients with metastasis size of < or = 5 cm. Univariate analysis showed that time of liver metastasis and metastasis size of > 5 cm were prognostic factors (P < 0.05); while node status of primary tumor, number of liver tumors, and carcinoembryonic antigen level had no significant relations with prognosis (P < 0.05). CONCLUSIONS: Hepatectomy may prolong survival time of colorectal cancer patients with liver metastases. Early diagnosis with intensive follow-up is crucial to increase the resectability of liver metastasis.