结直肠癌肝转移，左半肝多还是右半肝多？

因为转移癌细胞经门静脉血流进入肝脏，门静脉右支平直，左支迂曲，所以癌细胞多数进入右肝，推测结直肠癌肝转移多数为右肝转移。查阅相关文献：streamline effect

1、Relationship between primary colorectal tumour and location of colorectal liver metastases，ANZ J Surg 2016 May ;86(5)  IF=1.586

探讨原发肿瘤位置与肝转移位置相关性的研究，入组的891例患者，其中379例患者只出现右肝转移，156例左肝转移，356例双侧肝转移。

左半结肠癌肝脏转移的位置，与右半结肠肝脏转移的位置，无明显差异。

2、Location of liver metastases reflects the site of the primary colorectal carcinoma. Scand. J. Gastroenterol. 2008 ;43(2) IF=2.629

发现左半结肠癌与右半结肠癌，肝转移的部位不完全相同。178例入组病例，35例右半结肠癌，143例左半结肠癌（主要为乙状和直肠吧？）。35例右半结肠癌中，右半肝：左半肝转移比例为3.6:1，而左半结肠癌中，右半肝：左半肝=2.1:1。统计方法不同：计数左半肝和右半肝转移瘤个数，而参考文献1则分为三类：左半肝转移、右半肝转移和双侧肝转移三类。

结论：右半结肠癌更容易转移至右半肝，而左半结肠癌转移至左肝和右肝几率差不多。

The overall incidence of metastases located in the right lobe of the liver was 70.1% compared with 29.9% located in the left hemiliver.

Forty metastases (78.4%) from 35 carcinomas inthe right hemicolon were found in the right lobeof the liver, whereas 11 metastases (21.6%) werelocated in the left hemiliver. The results for the 143left-colon and rectum primaries were 145 metastases(68.1%) in the right hemiliver and 86 (31.9%) in theleft hemiliver. Accordingly, the ratio of metastasesinvolving the right and left lobe of the liver was 3.6:1for right-sided primary tumors (p<0.002) comparedwith 2.1:1 for left-sided primary tumors (p=NS) (Table I).

178例结直肠肝转移患者，统计分析肝转移瘤数目及位置，左半肝转移瘤30%，右半肝转移瘤70%。

3、Streamline flow of the portal vein affects the lobar distribution of colorectal liver metastases and has a clinical impact on survival Ann Surg Treat Res 2017 May ;92(5) if=1.233

总体来说，右肝转移率61%，左肝转移率 39%。右半结肠癌，右：左=123:56，而左半结肠癌，右：左=275:198。两者转移模式显著不同。本文进一步讨论了对预后的影响，如果是左半结肠癌，初诊只发现右半肝有转移，很有可能左半肝已经有潜在未发现的转移灶，将来复发概率高，预后差。而右半结肠癌，初诊时发现右肝转移，放心切除即可，因为右半结肠癌左半肝转移几率低，将来复发少，预后好一些。

Due to the relatively higher rate of metastasis to the left hemiliver, left-sided CRC has a higher risk of undetected metastasis in the left hemiliver at the time of right hemihepatectomy compared to right-sided colon cancer. Our data also showed that patients who underwent right hemihepatectomy for solitary metastasis had different rates of hepatic recurrence depending on primary tumor location.

4、Colorectal carcinoma metastases to the liver. Does primary tumor location affect its lobar distribution? Cancer 1996 Jun 01 ;77(11) IF=6.537

右半结肠癌 右肝转移29个病灶，3个左肝转移；而左半结肠癌，106右肝转移，57左肝转移。结论同上：左半和右半结肠癌，肝转移位置模式是不同的，右半结肠癌更多的右肝转移，而左半结肠癌两侧肝转移基本持平。