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Resektion von lebermetastasen kolorektaler tumoren

Eine uni- und multivariate analyse von prognosefaktoren

Resection of hepatic metastases from colorectal tumors: uni- and multivariate analysis of prognostic factors

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Abstract

Between September 1985 and December 1994, liver resections with curative intent were performed for liver metastases of colorectal primaries in 76 patients at the department for abdominal surgery of the university of Mainz. Perioperative morbidity and 30-day mortality rates were 30.3% and 6.6% respectively. The 3- and 5-year survival rate was 53% and 36% respectively. For patients with complete tumor removal (RO resection), excluding perioperative mortality, the following factors were associated with more prolonged survival after hepatic resection in univariate analysis. N1 stage of the colorectal primary compared to N2 stage (in patients with positive mesenterial lymph nodes); diameter of the largest metastasis between 2.1 and 3.5 cm; postoperative normalized CEA level (in patients with CEA level elevated to more than 4 ng/dl preoperatively); and wedge resections compared to hemihepatectomies. Regarding disease-free survival, only N1 stage of the colorectal primary compared to N2 stage and diameter of the largest metastasis between 2.1 and 3.5 cm had a positive influence. In multivariate analysis, the diameter of the largest metastasis was the only factor associated with survival time, while disease-free survival was influenced by the largest diameter of the metastasis, patient sex and N stage of the colorectal primary. Whether adjuvant therapies (systemic or regional chemotherapy) after curative resection of colorectal liver metastases is associated with better survival times remains an open question. Some of the above-mentioned prognostic factors may be helpful in selecting patients for entry into adjuvant therapy protocols.

Zusammenfassung

In der Klinik für Allgemein- und Abdominalchirurgie der Johannes-Gutenberg-Universität Mainz wurden in der Zeit von September 1985 bis Dezember 1994 76 Patienten mit Metastasen kolorektaler Primärtumoren unter kurativer Zielsetzung an der Leber reseziert. Die 30-Tage-Letalität und die Komplikationsrate betrugen 6,6 und 30,3%. Die 3- und 5-Jahres-Überlebens-wahrscheinlichkeit nach Lebermetastasenresektion lagen bei 53 und 36%. Innerhalb der Patienten mit R0-Resektion (ohne Letalität) hatten bein univariater Analyse folgende Faktoren einen günstigen Einflu\ auf dieÜberlebens-wahrscheinlichkeit: N1-Klassifikation des Primärtumors im Vergleich zu N2 (bei Patienten mit mesenterialem Lymphknotenbefall), Durchmesser der grö\ten Lebermetastase von 2,1–3,5 cm, ein postoperative normalisierter CEA-Serumspiegel (jeweils bei Patienten mit präoperativ auf > 4 ng/ml erhöhtem CEA-Serumspiegel) und periphere Leberresektionen und Segmentresektionen im Vergleich zu Hemihepatektomien. Auf dasrezidivfreie Überleben hatten nur die N-Klassifikation des Primärtumors N1 im Vergleich zu N2 (bei Patienten mit mesenterialem Lymph-knotenbefall) und der Durchmesser der grö\ten Lebermetastase von 2,1–3,5 cm einen günstigen Einflu\. In der multivariaten Analyse war der Durchmesser der grö\ten Lebermetastase (2,1–3,5 cm am günstigsten) der einzige unabhängige Faktor für dieÜberlebenswahrscheinlichkeit, während in bezug auf dierezidivfreie Überlebens-wahrscheinlichkeit neben dem. Metastasendurchmesser auch das Patientengeschlecht (weiblich besser als männlich) und die N-Klassifikation des Primärtumors (N1 besser als N2) als unabhängige Prognosefaktoren bestätigt wurden. Inwieweit adjuvante Therapiema\nahmen (systemische oder regionale Chemotherapie) nach Metastasen-resektion eine Verbesserung der Prognose nach Leberresektion bewirken können, mu\ z.Z. noch offen bleiben. Jedoch könnten die oben genannten Prognosefaktoren z.T. für die Auswahl von Patienten, die in Studien zur post-operativen adjuvanten Chemotherapie eingebracht werden sollen, hilfreich sein.

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  1. Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Universitätskliniken, Johannes-Gutenberg-Universität, Langenbeckstraße 1, D-55131, Mainz

    J. K. Seifert & T. Junginger

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Seifert, J.K., Junginger, T. Resektion von lebermetastasen kolorektaler tumoren. Langenbecks Arch Chiv 381, 187–200 (1996). https://doi.org/10.1007/BF00571684

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