Læknablaðið - 15.07.2001, Blaðsíða 15

FRÆÐIGREINAR / LIFRARMEINVÖRP
Lokaorð
Erfitt er að segja til um nákvæmlega hversu margir
sjúklingar hér á landi þarfnast lifrarúrnáms vegna
lifrarmeinvarpa, rislil- og endaþarmskrabbameins.
Nútíma tækni í skurðlækningum og gjörgæslu gerir
kleift að fjarlægja allt að 80% lifrarinnar með
skurðdauða undir 5% (25,30,31,46-48,55,59). Gera
má ráð fyrir að 10-30% af Iifrarmeinvörpum frá
krabbameini í ristli og endaþarmi séu skurðtæk ef
atriðin að ofan eru höfð til hliðsjónar við val á
sjúklingum fyrir skurðaðgerð (68,71-73). Á íslandi
greinast árlega 110 sjúklingar með krabbamein í ristli
og endaþarmi. Pví gætu 10 til 12 sjúklingar á ári
komið til greina fyrir lifrarúrnám og af þeim gætu
þrír til fjórir læknast, sé miðað við ofannefndar
lifunartölur eftir skurðaðgerð. Staðreyndin er sú að
örfáir þessara sjúklinga gangast undir lifrarúrnám
hér á landi. Þess vegna er mikilvægt að koma þeim
skilaboðum til lækna að árangur eftir lifrarúrnám fer
batnandi og full ástæða er til að rannsaka sjúklinga
með lifrarmeinvörp nánar með lifrarskurðaðgerð í
huga.
Þakkir
Roland Anderson prófessor og yfirlæknir við
skurðdeild Háskólasjúkrahússins í Lundi fær
sérstakar þakkir fyrir yfirlestur greinarinnar og
ábendingar.
Heimildir
1. Skýrsla 2000. Ársskýrsla Krabbameinsfélags íslands lögö fram
á aðalfundi 6. Maí 2000. Reykjavík: Krabbameinsfélag Islands;
2000.
2. Bengmark S, Hafström L. The natural history of primary and
secondary malignant tumors of the liver: I. The prognosis for
patients with hepatic metastases from colonic and rectal
carcinoma by laparotomy. Cancer 1969; 23:198-202.
3. Fortner JG, Silva JS, Golbey RB, Cox EB, Maclean BJ.
Multivariate analysis of a personal series of 247 consecutive
patients with liver metastases from colorectal cancer. I.
Treatment by hepatic resection. Ann Surg 1984; 199: 306-16.
4. Kemeny N, Schneider A. Regional treatment of hepatic
metastases and hepatocellular carcinoma. Curr Probl Cancer
1989; 13:199-283.
5. Welch JP, Donaldsson GA. The clinical correlation of an
autopsy study of recurrent colorectal cancer. Ann Surg 1979;
189: 496-500.
6. Pestana C, Reitemeier RJ. Moertel CG. The natural history of
carcinoma of the colon and rectum. Am J Surg 1964; 108: 826-
9.
7. Ekberg H, Tranberg KG, Andersson R, Lundstedt C,
Hagerstrand I, Ranstam J, et al. Pattern of recurrence in liver
resection for colorectal secondaries. World J Surg 1987; 11:
541-7.
8. Bozzetti F, Doci R, Bignami P, Morabito A, Gennari L.
Patterns of failure following surgical resection of colorectal
cancer liver metastases. Rational for a multimodal approach.
Ann Surg 1987; 205: 264-70.
9. Jaffe BM, Donegan WL, Watson F, Spratt JS Jr. Factors
influencing survival in patients with untreated hepatic
metastases. Surg Gyn Obstet 1968; 127:1-11.
10. Bengtsson G, Carlsson G, Hafström L, Jonsson PE. Natural
history of patients with untreated liver metastases from
colorectal cancer. Am J Surg 1981; 141: 586-9.
11. Fong Y, Kemeny N, Paty P, Blumgart LH, Cohen AM.
Treatment of colorectal cancer: hepatic metastasis. Semin Surg
Oncol 1996; 12:219-52.
12. Leichman CG, Fleming TR, Muggia FM, Taingen CM,
Ardalen B, Doroshow JH, et al. Phase II study of fluorouracil
and its modulation in advanced colorectal cancer: a Southwest
Oncology Group study. J Clin Oncol 1995; 13:1303-11.
13. Levi F, Zidani R, Misset JL. Randomized multicenter trial of
chronotherapy with oxaliplatin, fluorouracil, and folinic acid
in metastatic colorectal cancer. International Organization for
Cancer Chronotherapy. Lancet 1997; 350: 681-6.
14. Kemeny MM, Goldberg D, Beatty D, Blayney D, Browning S,
Doroshow J, et al. Results of a prospective randomized trial of
continuous regional chemotherapy and hepatic resection as
treatment of hepatic metast from colorectal primaries. Cancer
1986; 57: 492-8.
15. Reappraisal of hepatic arterial infusion in the treatment of
nonresectable liver metastases from colorectal cancer. Meta-
Analysis Group in Cancer. J Natl Inst 1996; 88:252-8.
16. Cunningham D, Pyrhonen S, James RD. Randomised trial of
irinotecan plus supportive care versus supportive care alone
after fluorouracil failure for patients with metastatic
colorectal cancer. Lancet 1998; 352:1413-8.
17. Mohiuddin M, Chen E, Ahmad N. Combined liver radiation
and chemotherapy for palliation of hepatic metastases from
colorectal cancer. J Clin Oncol 1996; 14: 722-8.
18. Holt RW, Nauta RJ, Lee TC, Heres EK, Dritschilo A, Harter
KW, et al. Introperative interstitial radiation therapy for
hepatic metastases from colorectal carcinomas. Am Surg
1988; 54: 231-3.
19. Morris DL, Ross WB. Australian experience of cryoablation
of liver tumors: metastases. Surg Oncol Clin N Am 1996; 5:
391-7.
20. Ravikumar TS, Kane R, Cady B, Jenkins R, Clouse M, Steele
GJ. A 5-year study of cryosurgery in the treatment of liver
tumors. Arch Surg 1991; 126:1520-3.
21. Korpan NN. Hepatic cryosurgery for liver metastases.
Longterm follow-up. Ann Surg 1997; 225: 193-203.
22. Adam R, Akpinar E, Johann M, Kunstlinger F, Majno P,
Bismuth H. Place of cryosurgery in the treatment of malignant
liver tumors. Ann Surg 1997; 63: 63-8.
23. Tandan VR, Harmantas A, Gallinger S. Long-term survival
after hepatic cryosurgery versus surgical resection for
metastatic colorectal carcinoma: a critical review of the
literature. Can J Surg 1997; 40:175-81.
24. Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup
DM. Resection of hepatic metastases from colorectal cancer.
Arch Surg 1984; 119: 647-51.
25. Huges KS, Simon R, Songhorabodi S, Adson MA, Ilstrup DM,
Fortner JG, et al. Resection of the liver for colorectal
carcinoma metastases: a multi-institutional study of patterns
of recurrence. Surgery 1988; 100: 278-88.
26. Schlag P, Hohenberger P, Herfarth C. Resection of liver
metastases in colorectal cancer. Competitive analysis of
treatment results in synchronous versus metachronous
metastases. Eur J Surg Oncol 1990; 16: 360-5.
27. Ringe B, Bechstein WO, Raab R, Meyer HJ, Pichlmayr R.
Leberresectionen bei 157 Patienten mit colorectalen
Metastasen. Chirurg 1990; 61: 272-9.
28. Doci R, Gennari L, Bignami P, Montalto F, Morabito A,
Bozzetti F. One hundred patients with hepatic metastases
from colorectal cancer treated by resection: analysis of
prognostic determinants. Br J Surg 1991; 78: 797-801.
29. Scheele J, Stangl R, Altendorf-Hofman A, Gall FP. Indicators
of prognosis after hepatic resection for colorectal secondaries.
Surgery 1991; 110: 13-29.
30. Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup
DM, van Heerden JA, et al. Perioperative blood transfusion
and determinants of survival after liver resection for
metastatic colorectal carcinoma. Ann Surg 1992; 216:493-504.
31. Scheele J, Stangl R, Altendorf-Hofman A, Paul M. Resection
of colorectal liver metastases. World J Surg 1995; 19: 59-71.
32. Doci R, Bignami P, Montalto F, Gennari L. Prognostic factors
for survival and disease-free survival in hepatic metastases
from colorectal cancer treated by resection. Tumori 1995; 81:
143-6.
33. Jaeck D, Bachellier P, Weber JC, Mourad M, Walf P.
Boudjema K. Surgical treatment of synchronous hepatic
metastasis of colorectal caners. Simoultaneous or delayed
resections? Ann Chir 1996; 50:507-12.
34. Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema
K, Bachellier P, Jaeck D. Surgical resection of colorectal
carcinoma metastases to the liver. A prognostic scoring
system to improve case selection, based on 1568 patients.
Ásssociation Francaise de Chirurgie. Cancer 1996; 77: 1254-
62.
35. Taylor M, Forster J, Langer B, Taylor BR, Greig PD, Mahut C.
A study of prognostic factors for hepatic resection for
colorectal metastases. Am J Surg 1997; 173: 467-71.
36. Nadig DE, Wade TP, Fairchild RB, Virgo KS, Johnson FE.
Læknablaðið 2001/87 611