手术治疗对于同时性结直肠癌肝转移预后的影响

The effect of surgical resection on the prognosis of colorectal carcinoma with synchronous hepatic metastases

目的探讨手术治疗对结直肠癌同时性肝转移患者生存的影响。方法回顾性分析2003年1月至2013年12收治的953例结直肠癌同时性肝转移患者的临床资料，采用单因素和Cox比例风险回归模型分析手术治疗对患者生存的影响。结果肝转移灶切除患者的中位生存期为46．7个月，5年存活率32％，显著优于非手术组（17个月，4％）；肝转移灶切除指征扩大后，切除率明显升高（31％比13．6％，P〈0．050）；肝转移灶可切除患者中，同期切除肠道原发灶和肝转移灶相对于分期切除，住院费用明显减少（36698元比45134元，P〈0．05）；肝转移灶不可切除且原发灶无症状的患者中，原发灶切除的患者总体中位生存时间明显优于原发灶未切除的患者（18个月比15个月，P〈0．05）。结论结直肠癌合并同时性肝转移患者中，扩展肝转移灶切除手术指征不增加并发症发生率及肿瘤复发率；原发灶和转移灶均可切除的可予以同期切除；对于不可切除的肝转移者仍建议切除不伴有合并症的肠道原发灶。

Objective To investigate the effect of surgical treatment on survival in colorectal carcinoma patients with synchronous hepatic metastasis. Methods The retrospective case-control study was done on 953 consecutive patients with synchronous coloreetal hepatic metastasesl from January 2003 to December 2013. Results Median survival time （46.7 months）and 5-year survival rate （32%） for patients with resected hepatic metastases was significantly superior to that of with nonoperative treatment （ 17 months, 4% ）. Expanded criteria for hepatic metastases resection raised resection rates （31% vs. 13.6% , P 〈0. 05 ）. For patients with resectable hepatic metastases, the inhospital cost for simultaneous resection group was lower than that in the staged resection group （36 698 vs. 45 134 RMB, P 〈 O. 05 ）. For patients of asymptomatic primary tumor with unresectahle hepatic metastases, resection of the primary tumor was associated with an improved median survival （ 18.0 vs. 15.0 months, P 〈 0.05 ） Conclusions Expanding indications of hepatic metastases resection can improve survival in patients with synchronous colorectal hepatic metastases. Simultaneous resection of primary tumor and hepatic metastases were indicated in patients with rcsectable synchronous colorectal hepatic metastases. Resection of primary tumor was recommended for asymptomatic patients with unresectable hepatic metastases.