| 作者 |
Hsin-Yuan Hung, Jy-Ming Chiang, Chung-Rong Changchien, Chien-Yuh Yeh,Jinn-Siun Chen, Reiping Tang, Wen-Sy Tsai, Pao-Shiu Hsieh, Chung-Wei Fan |
| 摘要 |
Objectives: For patients with unresectable synchronous liver metastasis, the
treatment is complex and the advantages of palliative resection of the primary colon
tumor have not been finally determined. Surgeons sometimes experience difficulty
deciding to implement palliative primary colon cancer resection. The choice should
depend on surgical risk, severity of symptoms and life expectancy. This study was
designed to identify factors reducing survival post palliative surgery among patients
with unresectable liver metastasis.
Methods: A retrospective review of 212 colon cancer patients with unresectable liver
metastases who received palliative surgery from 1995 to 2000 was conducted in this
study. Clinical-pathological data were collected from medical records. Significance
testing was performed using the Kaplan-Meier method to analyze survival difference
and the Cox proportional hazard model for independent prognostic factor.
Results: Altogether 183 patients received palliative resection of primary colon
cancer and 29 patients received non-resection (bypass or diversion) surgery. Factors
evaluated for survival were age, gender, comorbid heart disease, hemoglobin,
albumin, bilirubin, tumor size, tumor cell differentiation, tumor resection, extent of
liver metastasis, extent of systemic metastasis and chemotherapy. There were 15 postoperative
deaths. The mean survival was 12.6 months for the palliative resection
group and 4.7 months for the non-resection group. Patients with poor tumor differentiation,
advanced liver metastases, multiple systemic metastases and absence of
chemotherapy had significantly worse rates of survival.
Conclusions: Palliative surgery for asymptomatic or minor symptomatic patients
with poor tumor differentiation, advanced liver metastases or multiple systemic
metastases is of limited survival benefit, unless the tumors are complicated with
obstruction, perforation or bleeding. Postoperative chemotherapy is advocated after
any type of palliative resection. |
