Abstract
Over a 10-year period, 166 patients underwent liver resection with curative intent for colorectal secondaries. These included 23 (13.8 %) with metastases invading to adjacent organs. Diaphragm (n = 9), major omenturn (n = 5), portal vein/inferior vena cava (n = 3), gallbladder/extrahepatic biliary system (n = 3), right adrenal gland (n = 2), and lymph nodes of the hepatoduodenal ligament (n = 1) were resected en bloc together with the metastases. Operative mortality was 4.3% (1/23 patients). Intraoperative findings and the pathologist's report led to the performance of R0 resection in 14 patients, and microscopic residual disease after R1 resection was found in 7 patients; in 2 cases macroscopically visible tumour had to be left behind. Median survival for all patients was 14 months and was significantly less favourable than in patients who had undergone resection of metastases confined to the liver (P = 0.011, long-rank test). The median recurrence-free interval was 6.8 months (P = 0.11). Obviously, patients who had undergone R0 resection and whose CEA serum levels returned to normal after operation benefited the most, and among these a median survival of 17 months was recorded. It is concluded that in patients with liver metastases from colorectal cancer, invasion of the metastases to adjacent organs has significant implications for the prognosis, even if the metastases are resected. It is important to detect this situation preoperatively, to avoid subjecting patients to a treatment that offers little benefit.
Zusammenfassung
In einem Zehnjahreszeitraum wurde bei 166 Patienten eine Leberresektion wegen Metastasen kolorektaler Karzinome mit kurativer Zielsetzung vorgenommen. Bei 23 Patienten (13,8%) lag eine die Organgrenze der Leber überschreitende Metastasierung vor. Infiltrationen ins Diaphragma (n = 9), Omentum majus (n = 5), Pfortader/V. cava inferior (n = 3), Gallenblase/extrahepatische Gallenwege (n = 3), Nebenniere (n = 2) und Lymphknoten des Ligamentum hepatoduodenale (per continuitatem n = 1) wurden reseziert. Die Operationsletalität betrug 1/23 (4,3 %). Intraoperativ und nach histopathologischem Befund wurde bei 14 Patienten eine R0-Resektion, bei 7 Patienten eine R1-Resektion und bei 2 Patienten eine R2-Resektion erreicht. Die mediane Überlebenszeit betrug 14 Monate und war signifikant ungünstiger (p = 0.011, Log-rank-Test) im Vergleich zu Patienten nach Resektion auf die Leber beschränkter Metastasen. Die mediane rezidivfreie Überlebenszeit betrug 6,8 Monate vs. 10,5 Monate (p = 0,11). Bei Patienten mit die Organgrenze der Leber überschreitender Metastasierung eines kolorektalen Karzinoms muß auch nach erweiterter Resektion von einem signifikant ungünstigeren Verlauf ausgegangen werden. Es gilt, these Situation präoperativ durch extensive Diagnostik zu erkennen, um nicht Patienten einer operativen Behandlung zuzuführen, von der she nur eingeschränkt profitieren.
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Teile dieser Arbeit wurden auf der 109. Tagung der Deutschen Gesellschaft für Chirurgie in München vom 21. bis 25.04. 1992 vorgestellt und in Abstractform im Kongreßband veröffentlicht
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Hohenberger, P., Schlag, P. & Herfarth, C. Erweiterte resektion von lebermetastasen beim kolorektalen Karzinom. Langenbecks Arch Chir 378, 110–114 (1993). https://doi.org/10.1007/BF00202119
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DOI: https://doi.org/10.1007/BF00202119