Lochan R, White S A, Manas D M
Department of Hepatobiliary Surgery, The Freeman Hospital, High Heaton, Newcastle upon Tyne, Tyne and Wear, NE7 7DN, UK.
Surg Oncol. 2007 Jul;16(1):33-45. doi: 10.1016/j.suronc.2007.04.010. Epub 2007 Jun 4.
At some point in the natural course of colorectal cancer up to 50% of patients will develop metastasis to the liver. Historically only 20% of these patients would have to be deemed resectable, with an intent to cure, at the time of presentation. But with recent improvements in cross-sectional imaging, chemotherapeutic agents and advances in the techniques of surgical resection the emphasis of resection has now changed to 'who is not resectable' as opposed to 'who is resectable'. There are few contraindications to liver resection on the proviso that the patient is fit enough. As a result of this paradigm shift, 5 year survival rates are approaching 60%. Historically liver resection was perceived as a formidable operation but now liver resection for CRLM is safe and specialist centres are reporting mortality rates of less than 1%. This review briefly covers the standard techniques currently employed and some of the recent innovations being developed to improve resectability.
在结直肠癌的自然病程中，高达50%的患者会发生肝转移。从历史上看，这些患者中只有20%在就诊时被认为可以切除，目的是治愈。但随着近年来横断面成像、化疗药物的改进以及手术切除技术的进步，现在切除的重点已从“谁可以切除”转变为“谁不可以切除”。只要患者身体状况足够好，肝切除几乎没有禁忌证。由于这种范式转变，5年生存率接近60%。从历史上看，肝切除被视为一项艰巨的手术，但现在用于结直肠癌肝转移的肝切除是安全的，专业中心报告的死亡率低于1%。本综述简要介绍了目前采用的标准技术以及为提高可切除性而正在开发的一些最新创新。
