Simultaneous Resection for Patient with Resectable Synchronous Colorectal Cancer and Liver Metastasis, Comparing the Result between Laparotomy and Laparoscopic Groups: Our Experience at Chi-Mei Hospital

同時切除針對可手術切除的大腸癌合併肝轉移的患者，比較剖腹手術及腹腔鏡手術的成果：奇美醫院的經驗

高聖勛(Sheng Husn Kao) ； 馮已榕(I-Jung Feng) ； 鄭立勤(Li-Chin Jen) ； 陳漢坤(Han-Kun Chen) ； 林逸峰(Yi-Feng Lin) ； 王文慶(Wen-Ching Wang) ； 顏家聖(Chia-Sheng Yan) ； 孫定平(Ding-Ping Sun) ； 陳明鎮(Ming-Jenn Chen) ； 田宇峯(Yu-Feng Tian) ； 周家麟(Chia-Lin Chou)

《中華民國大腸直腸外科醫學會雜誌》 31卷3期 (2020/09) Pp. 134-141

https://doi.org/10.6312/SCRSTW.202009_31(3).10901

摘要

Purpose. This study aimed to determine the trend and changes demonstrated through our experience with surgical treatment and short-term results of resectable synchronous colorectal cancer with liver metastasis. Methods. This retrospective study enrolled 37 patients with primary colorectal cancer and associated liver metastasis who underwent simultaneous colorectal and liver resection at Chi Mei Hospital between 2011 and 2017. Twenty-three patients underwent colorectal and liver resection using the open method, and 14 patients underwent laparoscopic surgery. Patients' demographic and clinical data, including operative details, tumor-related parameters, and postoperative outcomes, were analyzed retrospectively. Results. Demographic features and pathologic results were similar between groups, except for primary tumor location. Although mean operative time was similar between groups (open group 417.39 ± 126.42 minutes vs. laparoscopic group 423.86 ± 146.60 minutes, p = 0.8922), mean operative blood loss was greater in the open group (976.09 ± 765.87 ml vs. laparoscopic 546.43 ± 495.54 ml, p = 0.0458). Open group patients had significantly more intraoperative blood transfusions than laparoscopic group patients (86.96% versus 35.71%, p = 0.0028). No statistically significant differences were found in protective ostomy, post-operative ICU admissions, days of ventilator weaning, duration of ICU stay and post-operative complications. No significant differences were found between groups in postoperative recurrence and overall, disease-free, and cancer-specific survival. Conclusion. The laparoscopic surgical approach for primary colorectal cancer and liver metastasis is the mainstream approach and the trend at Chi-Mei Hospital. With careful evaluation and patient selection, laparoscopic surgery provides a feasible and safe treatment choice for these patients.

關鍵字

Colorectal cancer ； Colorectal liver metastasis ； Surgical resection

並列摘要

目的：該回顧性研究目的，是要分析大腸癌同時合併肝轉移的患者在奇美醫院接受手術治療上的趨勢及改變。方法：從2011年1月至2017年12月，在奇美醫學中心有2854位新診斷的大腸直腸癌患者，其中有37位大腸癌同時合併肝轉移的患者接受同時性大腸及肝臟切除手術。這些人分成兩組：23人接受開腹式同時大腸及肝臟切除術，另外14人接受腹腔鏡同時大腸及肝臟切除術。病人臨床統計資料，手術細項，術後結果進行分析。結果：病人個別特徵及腫瘤期別在這兩組是相似的，除了原發腫瘤位置。平均手術時間在此兩組是類似的（開腹組417.39 ± 126.42對比腹腔鏡組423.86 ± 146.60分鐘；p =0.8922），但平均的失血量在開腹組在統計上是較多（976.09 ± 765.87 對比546.43 ± 495.54mL，p = 0.0458）。因此，在開腹組中手術時輸血的機率對比腹腔鏡組要來的高 （開腹組86.96% 對比腹腔鏡組35.71%，p = 0.0028）。而在保護性造口的施作、術後有無入住加護病房、拔管所需天數、加護病房的住院天數、術後併發症等，兩組在統計學上沒有明顯差異的。在術後短期的腫瘤復發率、短期總體生存率、短期無病存活率、短期大腸癌特定存活期等，在此兩組也是沒有統計學上差異的。結論：腹腔鏡下同時執行大腸及肝臟切除術，在奇美醫院已經是此類患者的手術主流。在小心篩選病人的情況下，腹腔鏡方式是相當安全且可行的手術選擇。

並列關鍵字

大腸直腸癌 ； 大腸直腸癌併肝轉移 ； 手術切除

參考文獻

De Greef K, Rolfo C, Russo A, et al. Multdisciplinary management of patients with liver metastasis from colorectal cancer. World J Gastroenterol. 2016; 22: 7215-25.

R. L. C. Araujo, M. Gonen, P. Herman. Chemotherapy for patients with colorectal liver metastases who underwent curative resection improves long-term outcomes: systematic review and meta-analysis. Annals of Surgical Oncology 2015; 22: 3070–8.

4. Q. Lin, Q. Ye, D. Zhu et al. Comparison of minimally invasive and open colorectal resections for patients undergoing simultaneous R0 resection for liver metastases: a propensityscore analysis, International Journal of Colorectal Disease 2015; 30: 385–95.

5. S. Berti, E. Francone, M. Minuto et al. Synchronous totally laparoscopic management of colorectal cancer and resectable liver metastases: a single center experience, Langenbeck's Archives of Surgery 2015; 400: 495–503.

6. J. A. Castellanos, N. B. Merchant, Strategies for management of synchronous colorectal metastases, Current Surgery Reports 2014; 2: article 62.