Schlag P M, Benhidjeb T, Stroszczynski C
Klinik für Chirurgie und Chirurgische Onkologie, Lindenberger Weg 80, Berlin D-13122, Germany.
Best Pract Res Clin Gastroenterol. 2002 Apr;16(2):299-317. doi: 10.1053/bega.2002.0286.
In 30-50% of patients the liver is a preferred site of distant disease for many malignant tumours. Due to the high incidence, most of the available data relate to metastases arising from colorectal primaries. Surgical resection is at present the only treatment offering potential cure. The achievable 5-year survival rate is 30%. However, only 10-15% of patients with colorectal liver metastases can undergo potentially curative liver resection. Therefore, accurate staging is an important prerequisite in selecting patients who would benefit from surgery. Recurrence of hepatic metastases after potentially curative resection occurs in up to 60% of the cases. Results demonstrate that re-resection of liver metastases can provide long-term survival rates in a carefully selected group of patients without extrahepatic disease. Because of the high rate of recurrences following an apparently curative resection several authors investigated the use of adjuvant chemotherapy (systemic, intraportal, and hepatic arterial infusion). Until recently none had shown effectiveness. Pre-operative chemotherapy seems to be a promising approach in patients with liver metastases initially considered unsuitable for radical surgery. Recently, neoadjuvant chemotherapy has been proposed as an alternative approach to conventional surgery as initial management with the aim of improving the results in resectable liver metastases. Interventional strategies (ethanol injection, cryosurgery, laser-induced thermotherapy, radio-frequency ablation) and combined modalities (surgical/interventional) are additive methods which may help to improve treatment results in the future.
在30%至50%的患者中，肝脏是许多恶性肿瘤远处转移的好发部位。由于发病率高，现有的大多数数据都与结直肠癌原发灶引起的肝转移有关。目前，手术切除是唯一有可能治愈的治疗方法。可达到的5年生存率为30%。然而，只有10%至15%的结直肠癌肝转移患者能够接受有可能治愈的肝切除手术。因此，准确分期是选择能从手术中获益的患者的重要前提。在接受了有可能治愈的切除术后，肝转移复发率高达60%。结果表明，对肝转移灶进行再次切除能够使一组经过精心挑选、无肝外疾病的患者获得长期生存率。由于在看似治愈性切除术后复发率很高，一些作者研究了辅助化疗（全身化疗、门静脉内化疗和肝动脉灌注化疗）的应用。直到最近，尚无研究显示其有效性。术前化疗对于最初被认为不适合根治性手术的肝转移患者似乎是一种有前景的方法。最近，新辅助化疗已被提议作为一种替代传统手术的初始治疗方法，目的是改善可切除肝转移的治疗效果。介入治疗策略（乙醇注射、冷冻手术、激光诱导热疗、射频消融）以及联合治疗方式（手术/介入）都是辅助性方法，可能有助于在未来改善治疗效果。
