大腸癌肝肺転移再切除例の検討

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  • Repeated Resection of Pulmonary and Hepatic Metastasis of Colorectal Cancer

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Introduction: Recurrence after aggressive surgical resection for hepatic and pulmonary metastasis in colorectal cancer is a major clinical problem. We retrospectively studied on indications and operations for such repeated resection. Methods: We reviewed 36 cases of colorectal cancer involving hepatic and pulmonary metastasectomy at our hospital in the last 5 years: 16 involved hepatic metastasis alone, 5 pulmonary metastasis alone, and 15 combined hepatic and pulmonary metastases (six with synchronized resection). Results: The interval from resection of the primary lesion to hepatic metastasis was 2-35 months (mean: 8.5 months), and that to pulmonary metastasis 7-43 months (mean: 15.4 months). The stage of hepatic metastasis was H1 (n=27). H2 (n=4) and hepatic metastasectomy Hr0 (n=17). Hr1 (n=4). Hr2 (n=10). The stage of pulmonary metastasis was LM1 (n=12), LM2 (n=7) and pulmonary metastasectomy was wedge resection (n=16), lobectomy (n=3). The recurrence ratio after hepatic metastasectomy was 46.6%(14/30) and 9 of 14 cases underwent repeated resection. The recurrence ratio after pulmonary metastasectomy was 47.3%(9/19) and 6 of 9 cases underwent repeated resection. Cumulative survival 3 years after first hepatic and pulmonary metastasectomy was 69.7% and 44.6% at 5 years. No significant difference was seen between metastasis stage and operation type. Patients undergoing repeated resection for metastasis of the residual liver and lung showed the longest survival at 21-59 months. Conclusion: The recurrence ratio after hepatic and pulmonary metastasectomy of colorectal cancer was high at about 47%, that patients treated by aggressive resection showed a favorable prognosis of 69.3% survival at 3 years survivals, and 44.6% at 5 years. Repeated metastasectomy in metastasized colorectal cancer thus appears justifiable.

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