Shankar A, Leonard P, Renaut A J, Lederman J, Lees W R, Gillams A R, Harrison E, Taylor I
Department of Surgery, Royal Free and University College Medical School, University College London, Charles Bell House, 67-73 Riding House Street, London W1P 7LD, UK.
Ann R Coll Surg Engl. 2001 Mar;83(2):85-8.
Liver resection improves survival in selected patients with colorectal liver metastases. However, the majority of patients with colorectal liver metastases have inoperable disease at presentation. Neo-adjuvant therapy (systemic or regional chemotherapy and interstitial laser therapy) used singly or in combination may convert a selected group of patients with irresectable liver metastases into an operable state.
We report a series of patients with initially inoperable multiple colorectal liver metastases who became operable after neo-adjuvant therapy. Operability was defined as unilateral disease limited to the liver. Twelve patients (7 female, 5 male, median age 57 years, range 38-69 years) with multiple inoperable colorectal liver metastases (8 synchronous, 4 metachronous) were initially treated with systemic chemotherapy (n = 7), hepatic arterial chemotherapy (n = 2) and chemotherapy plus interstitial laser therapy (n = 3).
In all cases, a significant response was achieved which enabled subsequent liver resection to be undertaken. There was only one postoperative complication (8%) and no peri-operative deaths. 3 patients were operated on within the last 12 months and are still alive. Of the remainder, 1 died within 1 year with recurrent disease. The remaining patients have a median survival of 2.5 years, range 1.39-4 years.
These results are similar to those reported for patients undergoing resection for operable metastases without neo-adjuvant therapy. Aggressive multimodality treatment of colorectal liver metastases in specialised centres may improve the resectability rates and survival in a selected group of patients.
肝切除可提高部分结直肠癌肝转移患者的生存率。然而，大多数结直肠癌肝转移患者在初诊时即存在无法手术切除的病灶。新辅助治疗（全身或区域化疗以及间质激光治疗）单独或联合使用，可能会使部分原本无法切除的肝转移患者转变为可手术状态。
我们报告了一系列初诊时无法手术切除的多发结直肠癌肝转移患者，他们在接受新辅助治疗后变为可手术切除。可手术性定义为仅限于肝脏的单侧病灶。12例患者（7例女性，5例男性，中位年龄57岁，范围38 - 69岁）患有多发无法手术切除的结直肠癌肝转移（8例同时性，4例异时性），最初接受全身化疗（7例）、肝动脉化疗（2例）以及化疗联合间质激光治疗（3例）。
所有病例均取得了显著疗效，使得后续能够进行肝切除。术后仅出现1例并发症（8%），无围手术期死亡。3例患者在过去12个月内接受了手术，目前仍存活。其余患者中，1例在1年内因疾病复发死亡。其余患者的中位生存期为2.5年，范围为1.39 - 4年。
这些结果与未接受新辅助治疗的可手术切除转移瘤患者的报道结果相似。在专业中心对结直肠癌肝转移进行积极的多模式治疗，可能会提高特定患者群体的可切除率和生存率。
