Lupinacci Renato, Penna Christophe, Nordlinger Bernard
Hôpital Ambroise-Paré, Service de Chirurgie Digestive, 9 av Charles De Gaulle, 92100 Boulogne Billancourt, France.
Surg Oncol Clin N Am. 2007 Jul;16(3):493-506, vii-viii. doi: 10.1016/j.soc.2007.04.014.
The field of surgery for liver metastases is evolving rapidly. The proportion of patients viewed as amenable to resection is increasing with surgeons becoming more aggressive and systemic therapy more effective. Surgical resection is associated with low mortality and overall 5-year survival approaching 40%. Best candidates for resection are those with stage I or II colorectal cancer, fewer than 4 hepatic lesions, no lesions larger than 5 cm in diameter, no evidence of extra-hepatic disease, CEA level less than 5 ng/mL, and a disease-free interval of at least 2 years. Perioperative chemotherapy with or without biotherapies, in-situ ablation techniques, portal vein embolization, and staged hepatectomy have extended the indications without lessening the results of liver resection for colorectal metastases.
肝转移瘤的外科治疗领域正在迅速发展。随着外科医生更加积极主动且全身治疗更加有效，被认为适合进行切除手术的患者比例正在增加。手术切除的死亡率较低，总体5年生存率接近40%。最适合切除的患者是那些患有I期或II期结直肠癌、肝内病灶少于4个、直径大于5 cm的病灶不存在、无肝外疾病证据、癌胚抗原（CEA）水平低于5 ng/mL且无病间期至少为2年的患者。围手术期化疗联合或不联合生物疗法、原位消融技术、门静脉栓塞和分期肝切除术扩大了手术适应证，同时并未降低结直肠癌肝转移灶肝切除的疗效。
