原发性肝癌术后复发和肝外转移灶再切除的疗效分析(附267例随访)(英文)

An Analysis of Prospective Outcome of Re-resection for Recurrent Live Cancer and Extrahepatic Metastases,a Follow-up of 267\Cass

目的 原发性肝癌手术切除后 ,复发是大多数患者术后的死亡原因。本文旨在评价原发性肝癌术后复发和肝外转移灶再切除的疗效并总结经验。方法 对 196 0年 1月到 2 0 0 0年 7月的 2 6 7例再切除的复发性肝癌患者的临床资料进行回顾性分析 ,其中 2 0 5例行再次肝切除 ,5 1例行肝外转移癌切除 ,11例行复发性肝癌和肝外转移癌联合切除 ,并进行临床病理特征和手术类型和生存率的比较。结果 再次肝切除中 ,11.2 %患者行左外叶切除术 ,4.4%行半肝切除术或扩大半肝切除术 ,6 8.3 %行局部根治性切除 ,17.1%行亚段切除术。复发高峰 ( 6 4.4% )在 1～ 2年。二次手术后总的 1,3,5和 10年生存率为 81.0 % ,40 .3% ,19.4%和 9.0 % ,而三次手术后则为 77.5 % ,2 9 .8% ,13 .2 %和 6 .6 1%。中位生存时间为 44个月。肝外转移癌的再切除也延长了生存期。结论 结果表明局部根治性切除和亚段切除适用于大多数再次肝切除。复发高峰可能与门静脉癌栓及手术因素相关。再手术切除不但适用于肝内复发癌也适用于肝外转移癌。鉴于目前化疗或非手术治疗均不能达到比再切除更满意的效果 ,因此 ,再切除是复发性肝癌的首选治疗方法。

Objective To evaluate the prospective outcome and summarize experience in re-resection for recurrent liver cancer and extrahepatic metastases. Methods The clinical data of 267 patients with recurrent primary liver cancer (PLC) after re-resection from January 1960 to July 2000 were retrospectively analyzed. Re-hepatectomy was performed on 205 cases, resection of extrahepatic metastases on 51 cases and combined resection of recurrent liver cancer and extrahepatic metastases on 11 cases. The clinico-pathologic features, operation type and survival were compared. Results The types of liver re-resection included left lateral lobectomy in 11.2% of patients, hemihepatetomy and extended hemi-hepatectomy in 4.4%, local radical resection in 68.3%, other subsegmentectomy in 17.1%. The peak recurrence rate (64.4%) occurred at 1–2 years. The overall 1-, 3, 5- and 10-year survival rates after second resection were 81.0%, 40.3%, 19.4% and 9.0% respectively, while they were 77.5%, 29.8%, 13.2% and 6.61% respectively after the third resection. The median survival time was 44 months. The re-resection with extrahepatic metastases also provided the possibility of longer survival. Conclusion The results suggest that subsegmentectomy and local excision is appropriate for the hepatic repeat resection. The peak recurrence may be correlated with portal thrombus and operative factor. The re-resection can be indicated not only in intrahepatic recurrent metastases but also in extrahepatic metastases in selected patients. Re-resection has become the treatment of choice for recurrence of PLC, as neither chemotherapy nor other nonsurgical therapies can achieve such favorable results. Key words prospective outcome - re-resection - primary liver cancer - recurrence - extrahepatic metastases