结直肠癌多发性肝转移手术切除的疗效

Effect of surgical treatment for multiple liver metastases of colorectal cancer

目的探索结直肠癌多发性肝转移手术切除的疗效及预后影响因素。方法回顾性分析北京大学肿瘤医院肝胆外-科结直肠癌多发性肝转移灶（≥4个）手术切除的疗效。结果自2002年4月至2013年4月，结直肠癌肝转移手术切除患者共239例，肝转移灶数目大于等于4个共60例。60例患者术后中位生存期35．2个月，5年累积生存率28．2％（17／60），生存5年以上2例；全组中位无病生存期6．9个月，1例无病生存5年以上。无围手术期死亡，术后合并症发生率为36．7％（22／60）。COX模型多因素分析显示，大范围肝切除（半肝及以上切除）及肝转移灶≥7个是影响预后的独立危险因素。原发癌突破浆膜、肝转移灶最大径≥4cm、新辅助化疗及肝转移复发后的再切除也是预后的影响因素。结论多发结直肠癌肝转移即使≥4个病灶，手术切除仍能获益。肝转移局部切除生存结果优于大范围切除。肝转移复发后的再切除能够改善患者预后。

Objective To study the survival outcome and the survival-related factors in patients who received liver resection for multiple （≥4） liver metastases of colorectal cancer. Method The results for patients who received partial hepatectomy for four or more colorectal hepatic metastases carried out in the 1 st Department of HPB Surgery, Peking University Cancer Hospital were studied retrospectively. Results Between 2002 and 2013, of 239 patients, 60 patients with four or more colorectal hepatic metastases received partial hepatectomy. The median overall survival was 35.2 months and the 5-year survival was 28.2% （ 17/ 60）. There were two actuarial 5-year survivors. The median disease-free survival was 6.9 months, with 1 actuarial disease-free Survivor at 5 years. There were no perioperative deaths, and the perioperative morbidity was 36. 7% （22/60）. Major （hemi-liver or more） liver resection and 7 or more metastases were independently associated with poor survival outcome. Perineural Invasion （T4） of the primary tumor, size of the largest metastasis （ ≥4 cm）, neoadjuvant chemotherapy, and resection of recurrent disease were also associ- ated with survival outcome. Conclusions Long-term survival could be achieved after resection of multiple colorectal liver metastases. Minor resection for multiple eoloreetal metastases was superior in survival compared with major resection. Additional survival advantage could be achieved by resection of recurrent disease.