| 特集名 | 大腸癌切除後のサーベイランス -- 転移・再発を中心に | |
|---|---|---|
| 題名 | 総論 (1) 大腸癌の遠隔転移・リンパ節転移再発に対する外科的切除の実際 | |
| 発刊年月 | 2004年 03月 | |
| 著者 | 加藤 知行 | 愛知県がんセンター消化器外科部 |
| 著者 | 平井 孝 | 愛知県がんセンター消化器外科部 |
| 著者 | 金光 幸秀 | 愛知県がんセンター消化器外科部 |
| 【 要旨 】 | 要旨はありません。 | |
| Theme | The surveillance program after treatment of colorectal cancers | |
|---|---|---|
| Title | Surgery for colorectal liver, pulmonary and lymph node metastases | |
| Author | Tomoyuki Kato | Department of Gastroenterological Surgery, Aichi Cancer Center Hospital |
| Author | Takashi Hirai | Department of Gastroenterological Surgery, Aichi Cancer Center Hospital |
| Author | Yukihide Kanemitsu | Department of Gastroenterological Surgery, Aichi Cancer Center Hospital |
| [ Summary ] | The prognosis for patients with metastases from colorectal cancer that remain unresected is poor and complete resection of metastases is the only known treatment associated with long-term survival. For hepatic metastases there are two types of hepatic resection; anatomic resection and wedge resection. The five-year survival rate after hepatectomies is 20 to 50%. Repeated hepatectomies and regional lymphadenectomies may be effective in prolonging the survival of selected patients with hepatic metastases. The following factors were found to be predictors of poor long-term outcome: positive margins, regional lymph nodes which were positive, satellite nodules and invasive factors, extrahepatic disease, a large number of hepatic tumors, postoperative CEA level>5 ng/ml and postoperative CA19-9 levels>50 ng/ml. For pulmonary metastases there are the following types of treatments; wedge resection, lobectomy and pneumonectomy. The use of video assisted thoracic surgery (VATS) in the management of pulmonary metastases is being evaluated. The five-year survival rate is 16 to 62%. The important prognostic factors are follows: incomplete resection, hilar and mediastinal lymph node metastases, histology of the primary site, high preoperative CEA levels, and disease free interval from time of colectomy to pulmonary metastatectomy. Concerning lymph node metastases: In patients with para-aortic lymph node metastases, the median survival time was 24 months in patients receiving lymph node dissection and 4.5 months without lymph node dissection. In those with inguinal lymph node metastases, the median survival time was 37 months with lymph node dissection and 12 months without lymph node dissection. |
|