Abstract
長庚醫院一般外科與大腸直腸外科在6年之間，共作了32例因大腸主腸癌轉移至肝臟的肝切除。同時切除者10例，異時切除者22例。手術死亡率6.2%，併發症發生率18.7%。追蹤期間自8個月至76個月，三年的存活率為46.5%，而真實無病存活率為28%，最長存活者達6年。術後53%出現癌再發現象，其中再發於肝臟者占31%。與肝再發最有關的因子，包括年齡大於60歲，原發癌的分化程度及切除緣是否大於1公分三者；但多變數分析顯示，唯一有關的因子為切除緣是否大於1公分。本經驗顯示肝切除對大腸直腸癌的肝臟轉移為有效的治療方式。
Since 1970 hepatic resection has been a well?accepted procedure for treatment of liver metastasis secondary to colorectal cancer. Such resection has been done in thirty-two cases of colorectal liver metastasis between January 1986 and December 1991, in Chang Gung Memorial Hospital. The 21 male and 11 female patients had ages ranging from 35 to 70, with a mean of 56. Ten patients had synchronous resection, while the other twenty-two patients had metachronous resections done 12 to 70 months ( an average 25 months ) after colonic resection for primary lesion. Procedures of hepatic resection included 3 extended right lobectomies, 10 right lobectomies, 5 left lateral segmentectomies, 11 segment-oriented resections and 3 wedge resections. There were two operative mortalities (6.2%), with one caused by intraoperative inferior vena cava injury and the other from hepatic failure from cirrhosis. Six patients (19%) had minor postoperative complications. With follow up from 8 to 76 months, the longest patient survival was six years. Cumulative overall survival rates revealed for one year, 95.1% and for three, 46.5%. Actuarial disease-free survival rates were calculated as one year 73.4% and three year 28.5%. Seventeen patients (53%) deve?loped recurrences; in nine patients these occurred in the liver only. Univariate analysis disclosed that (1) for patients over 60 years old, (2) differentiation of primary tumor and (3) resection margin greater than 1 cm are three factors related to the hepatic recurrences. Multivariate analysis, however, reveals that only the resectional margin is a factor. In conclusion, hepatic resection is a safe and effective method to treat colorectalliver metastasis. To prevent hepatic recurrence after liver resection, adequate resectional margin is mandatory.
Since 1970 hepatic resection has been a well?accepted procedure for treatment of liver metastasis secondary to colorectal cancer. Such resection has been done in thirty-two cases of colorectal liver metastasis between January 1986 and December 1991, in Chang Gung Memorial Hospital. The 21 male and 11 female patients had ages ranging from 35 to 70, with a mean of 56. Ten patients had synchronous resection, while the other twenty-two patients had metachronous resections done 12 to 70 months ( an average 25 months ) after colonic resection for primary lesion. Procedures of hepatic resection included 3 extended right lobectomies, 10 right lobectomies, 5 left lateral segmentectomies, 11 segment-oriented resections and 3 wedge resections. There were two operative mortalities (6.2%), with one caused by intraoperative inferior vena cava injury and the other from hepatic failure from cirrhosis. Six patients (19%) had minor postoperative complications. With follow up from 8 to 76 months, the longest patient survival was six years. Cumulative overall survival rates revealed for one year, 95.1% and for three, 46.5%. Actuarial disease-free survival rates were calculated as one year 73.4% and three year 28.5%. Seventeen patients (53%) deve?loped recurrences; in nine patients these occurred in the liver only. Univariate analysis disclosed that (1) for patients over 60 years old, (2) differentiation of primary tumor and (3) resection margin greater than 1 cm are three factors related to the hepatic recurrences. Multivariate analysis, however, reveals that only the resectional margin is a factor. In conclusion, hepatic resection is a safe and effective method to treat colorectalliver metastasis. To prevent hepatic recurrence after liver resection, adequate resectional margin is mandatory.
| Original language | Chinese (Traditional) |
|---|---|
| Pages (from-to) | 1759-1766 |
| Journal | 中華民國外科醫學會雜誌 |
| Volume | 26 |
| Issue number | 3 |
| State | Published - 1993 |