Palliative Surgery for Colon Cancer with Unresectable Liver Metastasis

結腸癌病人同時合併不可切除肝臟轉移時，治療變成複雜，原發結腸腫瘤的姑息切除的利益還不確定。外科醫生有時很難決定是否需要切除原發結腸腫瘤，應該列入考量的因素有手術的風險；症狀嚴重程度和存活長短。若手術併發症太高或病人的預期存活太短或無明顯症狀，原發結腸腫瘤的姑息切除變成無好處。此回溯性研究，研究從1994到1998年212位結腸癌病人合併不可切除肝臟轉移接受姑息手術結果。其中183位病人接受原發結腸腫瘤的姑息切除，另外29位病人剖腹或是腸繞道手術，平均存活時間分別為12.6月和4.7月，全部病人平均存活時間為11.7月，有15位病人手術後死亡。影響無明顯症狀或是輕微症狀病人接受姑息手術後存活的因素為不良的腫瘤分化，嚴重肝臟轉移腫瘤，多重系統的轉移和缺少化學療法。總結而言，若此類病人有不良存活的因素，高手術危險且無明顯症狀，考慮暫緩姑息手術而先給予化學治療。
Objectives: For patients with unresectable synchronous liver metastasis, the treatment is complex and the advantages of palliative resection of the primary colon tumor have not been finally determined. Surgeons sometimes experience difficulty deciding to implement palliative primary colon cancer resection. The choice should depend on surgical risk, severity of symptoms and life expectancy. This study was designed to identify factors reducing survival post palliative surgery among patients with unresectable liver metastasis. Methods: A retrospective review of 212 colon cancer patients with unresectable liver metastases who received palliative surgery from 1995 to 2000 was conducted in this study. Clinical-pathological data were collected from medical records. Significance testing was performed using the Kaplan-Meier method to analyze survival difference and the Cox proportional hazard model for independent prognostic factor. Results: Altogether 183 patients received palliative resection of primary colon cancer and 29 patients received non-resection (bypass or diversion) surgery. Factors evaluated for survival were age, gender, comorbid heart disease, hemoglobin, albumin, bilirubin, tumor size, tumor cell differentiation, tumor resection, extent of liver metastasis, extent of systemic metastasis and chemotherapy. There were 15 postoperative deaths. The mean survival was 12.6 months for the palliative resection group and 4.7 months for the non-resection group. Patients with poor tumor differentiation, advanced liver metastases, multiple systemic metastases and absence of chemotherapy had significantly worse rates of survival. Conclusions: Palliative surgery for asymptomatic or minor symptomatic patients with poor tumor differentiation, advanced liver metastases or multiple systemic metastases is of limited survival benefit, unless the tumors are complicated with obstruction, perforation or bleeding. Postoperative chemotherapy is advocated after any type of palliative resection.