Surgical Outcome of Colorectal Adenocarcinoma in Patients with Liver Cirrhosis: A Study of 76 Consecutive Patients

目的：這項研究在一醫療機構對於大腸直腸腺癌合併肝臟硬化之病患接受手術治療後，針對手術有關的合併症和死亡原因的評估。 方法：從1995年到2003年，共有78位大腸直腸腺癌合併肝臟硬化之病患接受手術。除去數據不足以分析的病患，最後獲致76位病患於此次研究內被分析。年齡中位數為66.5歲，有57位男性和19位女性病患。依據Child’s 肝硬化分期，有45位病患是Child’s A，24位病患Child’s B和7位病患Child’s C。全部病患皆接受開腹手術，包括設置腸造廔而無腫瘤切除與腫瘤局部切除。 結果：主要的手術相關的合併症病狀包括︰6位傷口感染或裂開，4位胃腸道出血，有機能障礙的膀胱，腸阻塞，肺炎分別有2位。心血管病變，腹部敗血病，腹腔內部出血和腸道吻合不良各ㄧ位。住院中或術後三十日內之死亡率是6.57% (5/76)。根據Child’s class分級，在Child’s A，B和C的病患併發症之發生率分別是 7/76(15.6%)，8/24 (33.3%) 和5/7(71.4%) (p = 0.002)。取決於不同的Child’s class的死亡率是B︰3/24(12.5%)和C︰2/7(28.6%) (p = 0.002)。Child’s A class的病患沒有手術後相關的死亡率。 結論：大腸直腸腺癌合併Child’s class A和B肝臟硬化之病患可安全地接受大腸直腸腫瘤切除或開腹手術。然而隨著肝硬化之嚴重度增加，術後併發症的發生率也會提高。大腸直腸腺癌的分期並不影響手術相關併發症之發生率或致死率。因此，謹慎的選擇不同肝臟硬化程度的病患與完善的手術前後照顧，對於大腸直腸腺癌合併肝臟硬化需要手術治療之病患是相當重要的。
Background: This study was aimed at the evaluation of surgery-related morbidity and mortality in patients with concurrent colorectal adenocarcinoma and hepatic cirrhosis at a single institution. Materials and Methods: From 1995 to 2003, surgery was performed on seventy-eight colorectal adenocarcinoma patients with liver cirrhosis. A total of 76 patients were recruited to be analyzed in this study; two patients were excluded because of insufficient data. There were 57 male and 19 female patients, with a mean age of 66.5 years. Based on the modified Child-Pugh classification, 45 patients were Child’s class A, 24 patients Child’s class B and 7 patients Child’s class C. All patients underwent surgery, including enterostomy without tumor resection or local excision of the colorectal lesion. Results: Major morbidity included: 6 wound infections/dehiscence, 4 cases of gastrointestinal tract bleeding, 2 of dysfunctional bladder, 2 of ileus, 2 of pneumonia, one of cardiovascular compromise, one of intra-abdominal sepsis, one of internal bleeding and one of anastomosis insufficiency. The hospital mortality rate was 6.57% (5/76). Using Child classification grading, the morbidity rates for Child’s class A, B and C were 7/76 (15.6%), 8/24 (33.3%) and 5/7 (71.4%), respectively (p = 0.002). The mortality rates for different Child’s classes were: B 3/24 (12.5%) and C 2/7(28.6%) (p = 0.002). No postoperative procedure-related mortality was reported for Child’s class A classification. Conclusion: The colorectal cancer patients with Child-Pugh class A and B liver cirrhosis could tolerate colectomy or laparotomy with an acceptable risk. Further, with worsening liver function there is a higher morbidity rate. Cancer stage has a negative impact on surgery-related mortality or morbidity. Prudent selection of patients and comprehensive peri-operative care are warranted for colorectal malignancy concurrent with hepatic cirrhosis.