CAJ | 학술논문

目的：比较结直肠癌同时性肝转移患者原发灶和肝转移灶同期与分期切除的近期和远期结局。方法回顾性分析北京肿瘤医院肝胆胰外一科2003年1月至2011年12月间的64例结直肠癌合并同时性肝转移患者的临床及术后随访资料，其中行原发灶和肝转移灶同期切除者20例（同期切除组），分期切除者44例（分期切除组）。结果同期切除组Clavien-Dindo 1、2和3级并发症发生率分别为10．0％（2/20）、15．0％（3/20）和15．0％（3/20），分期切除组分别为13．6％（6/44）、13．6％（6/44）和22．7％（12/44），差异无统计学意义（P＞0．05）。同期切除组1、2和3年总体生存率分别为85．0％、59．6％和37．2％，分期切除组分别为90．9％、68．2％和47．1％，差异亦无统计学意义（均P＞0．05）。两组中位无病生存时间分别为6月和7月，差异亦无统计学意义（P＞0．05）。多因素预后分析显示，原发灶淋巴结阳性（P=0．020）和肝切除术前CEA水平大于20μg/L（P=0.017）是影响患者总体生存的独立危险因素；复发后有机会接受根治性局部治疗联合化疗则是一项保护性因素（P=0.001）；而手术时机（同期或分期切除）与患者总体生存无关（P＞0．05）。结论对于结直肠癌同时性肝转移，选择同期或分期切除并不影响患者的术后并发症发生率和远期生存率。
목적：비교결직장암동시성간전이환자원발조화간전이조동기여분기절제적근기화원기결국。방법회고성분석북경종류의원간담이외일과2003년1월지2011년12월간적64례결직장암합병동시성간전이환자적림상급술후수방자료，기중행원발조화간전이조동기절제자20례（동기절제조），분기절제자44례（분기절제조）。결과동기절제조Clavien-Dindo 1、2화3급병발증발생솔분별위10．0％（2/20）、15．0％（3/20）화15．0％（3/20），분기절제조분별위13．6％（6/44）、13．6％（6/44）화22．7％（12/44），차이무통계학의의（P＞0．05）。동기절제조1、2화3년총체생존솔분별위85．0％、59．6％화37．2％，분기절제조분별위90．9％、68．2％화47．1％，차이역무통계학의의（균P＞0．05）。량조중위무병생존시간분별위6월화7월，차이역무통계학의의（P＞0．05）。다인소예후분석현시，원발조림파결양성（P=0．020）화간절제술전CEA수평대우20μg/L（P=0.017）시영향환자총체생존적독립위험인소；복발후유궤회접수근치성국부치료연합화료칙시일항보호성인소（P=0.001）；이수술시궤（동기혹분기절제）여환자총체생존무관（P＞0．05）。결론대우결직장암동시성간전이，선택동기혹분기절제병불영향환자적술후병발증발생솔화원기생존솔。
Objective To compare the short- and long-term outcomes of patients with synchronous colorectal liver metastases receiving either simultaneous or staged hepatectomy. Methods Clinical and follow-up data of 64 patients with synchronous colorectal liver metastasis who underwent either simultaneous or staged hepatectomy between January 2003 and December 2011 in our hospital were reviewed retrospectively. Among them 20 patients underwent simultaneous resection of colorectal cancer and liver metastasis (simultaneous group) and 44 patients underwent staged operations (staged group). Results The Clavien-Dindo grade 1, 2, 3 complication rates in simultaneous group were 10.0%, 15.0% and 15.0% respectively, and were staged group 13.6%, 13.6% and 22.7% respectively in staged group, and the difference was not statistically significant (P>0.05). The 1-, 2- and 3-year overall survival rates in simultaneous group were 85.0%, 59.6% and 37.2% respectively, compared with 90.9%, 68.2% and 47.1% in staged group, and the difference was not statistically significant (P>0.05). The median disease-free survival time in simultaneous group was 6 months versus 7 months in the staged group, which was comparable (P>0.05). Multivariate analysis revealed that positive primary lymph-node (P=0.020), prehepatectomy CEA>20 μg/L (P=0.017) were independent risk factors of overall survival, and having the opportunity to receive local radical therapy combined with chemotherapy after recurrence was a protective factor (P=0.001), while the timing of resection (simultaneous or staged strategy) did not reach statistical significance according to overall survival (P>0.05). Conclusions For synchronous colorectal liver metastasis there are no significant differences in postoperative complication rate and long-term survival between curative simultaneous and staged resection.