| Part one Efficacy comparison between simple Surgery and surgery combined with intraoperative radiofrequency ablation of patients with colorectal cancer liver metastasis in patients with postoperativeObjective: To compare the postoperative efficacy of radiofrequency ablation combined with surgery alone and surgery in the treatment of patients with colorectal cancer metastasis.Methods: The data of clinical cases were from January 2010 to June 2013 in our hospital using surgery combined with intraoperative radiofrequency ablation of colorectal cancer patients with liver metastases and our hospital surgical treatment of colorectal cancer patients with liver metastases Materials,a total of 82 cases,including simple surgical resection in 50 cases(surgery alone group),surgery combined with intraoperative radiofrequency ablation in 32 cases(combined treatment group).Follow-up to December 1,2017,the out-patient review,admission review and phone follow-up methods were used.The definition of overall survival time was the interval between the date of surgery and the date of death in patients with primary tumor.82 patients were all valid follow-up.All patients in the above group were routinely performed blood routine,biochemical complete set,coagulation,recurrence or metastasis,postoperative survival time,time of death and causes of death.Results: The number of metastases in solitary surgery group was 28 cases single and 22 cases multiple.The number of metastases in combination group was 28 cases single and 22 cases multiple.Metastatic tumors in simple surgical treatment group involved 38 cases of single hepatic lobe and 12 cases of multiple lobes.In the combined group,14 cases of hepatic single lobe and 18 cases of multiple lobes were involved in the metastases.There were significant differences between the number of metastases and the number of metastatic tumor involving liver in surgical treatment group and combined treatment group(P <0.05).There were significant differences in sex,age,BMI,maximum diameter of tumor,Metastasis time,recurrence risk score,liver function grading and CEA value,the difference was not statistically significant(P> 0.05).A total of 156 lesions were excised from the surgical treatment alone.A total of 186 lesions were resected and 69 ablation lesions were ablated.The ablation rate was 27.06%(69/255).Among them,18 lesions were ablated,5 lesions were ablated,5 lesions were ablated,4 cases of 3 lesions,ablation of 5,6,7,9,10 lesions in 1 case.The operation time(165.09 ± 66.78)min and intraoperative blood loss of 276.3 ml in the combined treatment group were significantly lower than those in the simple operation group(230.28 ± 56.30)min and 389.7 ml.There was no significant difference in blood transfusion between the two groups(P> 0.05).The levels of AST,ALT,CHE and ALB in the surgery group were(32.52 ± 9.54)U / L,(40.41 ± 8.13)U / L,(5268.85 ± 924.45)mmol / L and(46.35 ± 3.13)g / L,and the combined treatment group were(33.58 ± 8.85)U / L,(42.14 ± 8.22)U / L,(5125.38 ± 1552.26)mmol / L and(45.47 ± 2.74)g / L,respectively.The levels of AST,ALT,CHE and ALB in the surgery group were(56.90 ± 11.20)U / L,(129.57 ± 32.30)U / L,1256.39 ± 13.40 mmol / L and 5.60 ± 1.12 g / L,and the combined treatment group were(45.09 ± 9.87)U / L,(87.56 ± 20.45)U / L,(674.41 ± 157.49)mmol / L and(1.68 ± 0.78)g / L,respectively.The levels of AST,ALT,CHE and ALB in the combined treatment group were significantly lower than those in the simple operation group after 3d(P <0.05).There were 3 incisional wound infections,1 incision fat liquefaction,2 incision incisions,1 abdominal infection,3 pleural effusion,2 bile leakage,2 intestinal obstruction and 2 gastrointestinal bleeding.Treatment group incision infection in 2 cases,1 case of pleural effusion,intestinal obstruction in 1 case.The incidences of postoperative complications in the surgery group and the combination therapy group were 32.00% and 12.50%,respectively,with significant difference between the two groups(P <0.05).There were 4,10 and 16 cases of recurrence or distant metastasis in the first,second,and third year respectively in the simple operation group,including 30 cases of simple intrahepatic recurrence,6 cases of lung metastasis,6 cases of liver metastasis,At the same time recurrence and metastasis in 3 cases,intrahepatic recurrent adrenal metastasis in 2 cases.There were 3,6 and 10 cases of recurrence or distant metastasis in the first,second,and third years respectively in the combination therapy group,with a total of 19 cases,including simple intrahepatic recurrence in 12 cases,lung metastasis in 3 cases,liver,lung and omentum Recurrence and metastasis in 4 cases.There was no significant difference in recurrence or distant metastasis within 3 years after surgery between the simple operation group and the combined treatment group(P> 0.05).The median duration of disease-free survival in the surgery alone group and the combined treatment group was 22.9 months and 22.8 months,respectively,with no significant difference between the two groups(P> 0.05).The 1,2,and 3-year survival rates were 72.00% and 62.50%,54.00% and 50.00%,34.00% and 34.38% in the surgery alone group and the combination therapy group respectively.There was no significant difference in survival rate between the operation-only group and the combination therapy group within 3 years(P> 0.05).The median overall survival time was 28.6 months and 27.5 months in the surgery alone group and the combination therapy group,respectively.There was no significant difference between the two groups(P> 0.05).Conclusion: Surgery combined with intraoperative radiofrequency ablation for colorectal cancer liver metastases can achieve similar prognosis as surgical resection,suggesting that surgery combined with intraoperative radiofrequency ablation and postoperative chemotherapy is a safe and effective treatment.Part two Prognosis factors analysis of colorectal cancer patients with liver metastasisObjective: To explore the factors that affect the prognosis of patients with liver metastases from colorectal cancer.Methods: The data of clinical cases were from January 2012 to June 2014 in our hospital using surgery combined with intraoperative radiofrequency ablation of colorectal cancer patients with liver metastases and our hospital surgical treatment of colorectal cancer patients with liver metastases Data,a total of 136 cases.The clinical and follow-up data of selected patients with liver metastases from colorectal cancer were collected by referring to the medical records,such as inpatient records,various auxiliary examination forms,and follow-up records,and the related contents were extracted using a unified form.The main contents include gender,age,number of liver metastases,intrahepatic distribution of liver metastases,diagnosis of primary colorectal cancer until the time of liver metastasis,the maximum diameter of liver metastases,whether liver metastases were removed,the location of the primary lesion,The degree of primary tumor differentiation,local lymph node metastasis,the depth of primary tumor invasion(T stage),the primary tumor was removed,with or without vascular thrombosis,whether extrahepatic metastasis,whether systemic chemotherapy,preoperative CEA value,hepatitis B antigen and preoperative hemoglobin value.Results: The 1-year survival rate was 69.85%(95/136),the 2-year survival rate was 50.0%(68/136),the 3-year survival rate was 38.24%(52/136),and the median survival time was 28.9 Months.The number of metastases,the number of liver tumors involved in metastases,the maximum diameter of metastases,the time of metastasis,the recurrence risk score,CEA value,the diagnosis of primary colorectal cancer to liver metastasis,the treatment of liver metastases,the location of primary tumor,The degree of tumor differentiation,T stage of primary tumor,with or without vascular thrombosis,whether primary resection had an effect on prognosis,the difference was statistically significant(P <0.05),but gender,age,liver function classification,liver External metastasis and hepatitis B surface antigen had no effect on prognosis,the difference was not statistically significant(P> 0.05).According to the standard of ? = 0.05,Cox regression model was used for multivariate analysis.The independent factors related to prognosis were the number of metastases,the number of metastatic tumor involving liver lobes,the maximum diameter of metastases,CEA value,the treatment of liver metastases,The location of primary tumor,the degree of primary tumor differentiation,and the surgical resection of the primary tumor(P <0.05).Conclusion: The prognosis of patients with liver metastases from colorectal cancer is affected by many factors.Surgical resection of liver metastases is still the best method to cure liver metastases of colorectal cancer.Active resection of liver metastases can prolong the survival time and improve Patient's prognosis.The survival rate after hepatectomy was related to the number of metastases,the number of liver metastases,the maximum diameter of metastases and the CEA value.The higher the degree of primary tumor differentiation,the more limited the distribution of liver metastases,the better the prognosis. |
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