多学科协作诊治团队模式治疗可切除的结直肠癌肝转移

A clinical study on multi.disciplinary team and surgery for resectable colorectal cancer with liver metastases

目的评价手术切除结直肠癌肝转移（CRCLM）的治疗效果，探索可切除CRCLM的多学科协作诊治团队（multi—disciplinary team，MDT）模式。方法回顾性分析2009年1月至2011年8月经过MDT诊治模式并接受手术治疗的38例CRCLM患者的临床资料，评价MDT诊治模式以及手术治疗的围手术期、生存效果。结果术前MDT评估38例患者均符合现有的肝转移癌“可切除性”标准，其中仅4例（10．5％）符合旧标准。38例患者均完成结直肠及肝脏切除术，共计切除结直肠肿瘤39个，切除肝脏转移灶155个。1例死于术后感染中毒性休克，围手术期病死率2．6％；1例术后发生胆漏，手术并发症发生率2．6％。38例患者中有13例接受新辅助化疗，所有患者术后均接受辅助化疗。患者随访7～59个月，平均随访（22±10）个月，复发及转移16例，其中6例死于肿瘤晚期恶液质。患者1、2、3年累计总生存率分别为94．4％、85．3％、75．8％，1、2、3年累积无瘤生存率分别为70．1％、54．2％、54．2％。结论对于可切除的CRCLM，MDT模式值得推荐；手术切除CRCLM是安全、可行的，短·中期生存效果是可以接受的，长期生存效果值得期待。

Objectives To analyze the survival outcomes of the surgery for colorectal cancer with liver metastases （CRCLM）, and study the mode of multi-disciplinary team （MDT） for CRCLM. Methods The retrospective analysis was conducted for 38 patients with CRCLM received MDT management and surgical treatment from January 2009 to August 2011. The peri-operative and survival outcomes of MDT and surgery were evaluated. Results All the eases met the present criteria of resetability for CRCLM, but only 4 cases （10. 5% ） met the previous one. Coloprocteetomy and hepatectomy were performed in all eases, with 39 colorectal neoplasms and 155 liver lesions removed. One case died of postoperative septic shock. Colorectal and hepatic specific complications were absent in the others patients except one ease of biliary leak which was treated with conservative management. Neoadjuvant chemotherapy was arranged in 13 eases. Adjuvant chemotherapy was administered for every patient. After a mean follow-up of （22 ± 10） months according to the finding time of liver metastases, recurrence and metastases were observed in 16 cases and 6 eases died of late-stage cachexia. The 1-, 2- and 3- overall survival rate were 94. 4% , 85.3% and 75.8% respectively, and the 1-, 2- and 3- disease-free survival rate were 70. 1% , 54. 2% and 54. 2% respectively. Conclusions MDT mode for reseetable CRCLM is recommendable. Surgical resection of CRCLM is feasible and safe, which seems to achieve favourable short-middle oncologic outcomes. And longterm survival is expected.