手术切除结直肠癌肝多个转移瘤的效果分析

目的对于结直肠癌患者肝内存在多个转移瘤,手术切除的价值存在争议,本文旨在研究手术切除大肠癌肝多个ΚΣ瘤的效果。方法回顾性分析1996年1月至2006年12月收治的经手术切除的结直肠癌肝转移瘤患者60例,比较肝内单个转移瘤(35例)与多个转移瘤(25例)患者临床和预后资料。结果两组均无手术死亡。多个转移瘤组和单个转移瘤组相比,手术并发症为12.0%vs11.4%(P=1.000);平均住院时间为(14.9±5.1)dvs(15.7±5.8)d(P=0.844);中位生存期为28个月vs35个月(P=0.089);中位无瘤生存期为16个月vs19个月(P=0.112);肝内复发率为72.0%vs51.5%(P=0.109)。多个转移瘤组3、5年总生存率分别是48.4%、30.8%,单个转移瘤组分别为68.6%、57.7%(P=0.165)。结论手术切除结直肠癌肝脏多个转移瘤可取得与单个转移瘤相似的效果。手术切除不应视为肝多个转移瘤的禁忌证。术后辅以全身化疗常可以改善预后。

Outcome of hepatectomy for patients with multiple hepatic metastases from colorectal cancer

Objective Survival benefit of resection for multiple liver metastases has not been established.This study was to investigate the effect of resection of multiple hepatic colorectal metastases.Methods Sixty patients with liver metastases from colorectal cancer received liver resection from Jan 1996 to Dec 2006,including 25 cases with two or more liver metastases,35 with solitary liver metastasis.Clinical and outcome data were retrospectively analyzed between multiple liver metastases and solitary liver metastasis.Results The perioperative morbidity rate was 12.0% in multiple metastases group and 11.4% in solitary metastasis group（P=1.000）,and no mortalityin either group.The respective mean hospital duration was（14.9±5.1）days and（15.7±5.8）days（P=0.844）,the median overall survival（OS） time was 28 and 35 months（P=0.089）,the median disease free survival（DFS） time was 16 and 19 months（P=0.112）,and the intrahepatic recurrencerates were 72.0 % and 51.5%（P=0.109）.The 3and 5year overall survival rates were 48.4%,and 30.8%,respectively,in multiple metastases group and 68.6%,57.7%,respectively,in solitary metastasis group（P=0.165）.Conclusions There is no significant differences of OS time and DFS time in two groups.Liver resection is not a contraindication for multiple liver metastases.In the current era of effective chemotherapy,aggressive approach with hepatectomy,followed by adjuvant chemotherapy could offer an improved prognosis for multiple liver metastases from colorectal carcinoma.