Медицинская литература. Новинки

 

 

 

 

 

 

Отдаленные результаты резекций печени у больных с метастазами колоректального рака и первичным раком печени

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Проведена сравнительная оценка радикальности сегментарной и обширной резекции при метастазах колоректального рака (МКРР) и первичном раке печени (ПРП). Отдаленные результаты прослежены у 102 больных (95%) с МКРР и 51 больного (77%) ПРП. Изучены результаты сегментарных резекций у 54 пациентов с МКРР и 16 пациентов с ПРП. Результаты обширных резекций анализированы у 48 больных МКРР и у 35 – ПРП. Общая трехлетняя выживаемость больных ПРП составила 50%, пятилетняя – 39%, десятилетняя – 25%; медиана – 36 мес. При МКРР трехлетняя выживаемость больных составила 35%, пятилетняя – 23%, десятилетняя – 15%; медиана – 22 мес. Применение современных цитостатиков у больных МКРР привело к увеличению пятилетней выживаемости до 42%. При МКРР пятилетняя выживаемость после сегментарной резекции составила 27%, после обширной резекции – 19% (p 0,05). При ПРП пятилетняя выживаемость после сегментарной резекции составила 53%, после обширной резекции – 37% (p > 0,05). При однофакторном регрессионном анализе группы больных МКРР отмечено достоверное влияние на выживаемость семи прогностических факторов, из которых при многофакторном регрессионном анализе подтверждено влияние на выживаемость только четырех: стадии поражения печени по Gennari (III, IV), уровня РЭА в плазме (более 200 нг/мл), отступа от края опухоли (1 см и более) и терапии современными цитостатиками. При однофакторном регрессионном анализе группы больных ПРП установлено достоверное влияние на выживаемость пяти прогностических факторов, при многофакторном регрессионном – четырех из них: стадии заболевания по TNM UICC6 (II–III/IV), метастатического поражения лимфоузлов, количества опухолей в печени, отступа от края опухоли (1 см и более). Выявлены достоверные отличия по III, IV стадиям по Gennari для больных МКРР между группами обширных и сегментарных резекций. Тем не менее объем резекции печени не влиял на выживаемость больных с одинаковой стадией по Gennari при МКРР. Таким образом, при МКРР и ПРП сегментарная резекция не уступает по радикальности обширной резекции и может являться ее альтернативой, тем более при снижении функционального резерва печени, исключающем обширную резекцию.

Ключевые слова:
сегментарная резекция печени, обширная резекция печени, метастазы колоректального рака, первичный рак печени.

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Remote Results Influence of the Resections in the Colorectal Cancer Metastasis and Primary Liver Cancer Patients

Segmental and major liver resections were compared on their curativeness in patients with colorectal liver metastases (CRLM) and primary liver cancer (PLC). Long term results were analyzed in 102 (95%) patients with CRLM and in 51 (77%) PLC patients. Fifty four (100%) patients with CRLM and 16 (84%) patients with PLC were followed up after segmental liver resections. Long term results after major liver resections were analyzed in 48 (89%) and 35 (75%) patients with CRLM and PLC respectively. Overall 3-year survival in PLC patients came to 50%, 5-year survival – 39%, 10-yearsurvival – 25% and median of survival– 36 months. In patients with CPLM 3–year survival came to 35%, 5-year survival – 23%, 5-year survival – 15% and median of survival – 22 months. Five-year survival dramatically increased up to 42% in patients with CRLM after irinotecan and oxaliplatin perioperative administration. In patients with CRLM 5-year survival after segmental liver resections came to 27%, after major resections – to 19% (p 0,05). In PLC patients 5-year survival after segmentectomies came to 53% and after major resections – to 37% (p > 0,05). Monofactorial regressive analysis in CRLM patients group revealed significant dependence of survival on 7 prognostic factors, only 4 of them (III, IV grades according to Gennari, the plasma level of CEA (>200 ng/ml) and resection free margin ≥1см) proved to influence on survival after multifactorial regressive analysis. Monofactorial regressive analysis in PLC patients group revealed significant dependence of survival on 5 prognostic factors. Four of them (TNM UICC6 (IIIII/IV) tumor stage, lymph node involvement, number of the liver tumors and resection free margin ≥1см) proved to influence on survival after multifactorial regressive analysis. There was significant difference in III, IV stages according to Gennari between patients with CRLM after segmental and major liver resections. But patients in both groups with the same stages ac

Keywords:
segmental liver resection, major liver resection, colorectal cancer liver metastases, primary liver cancer.