Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Hospital Josep Trueta, Girona, Spain.
HPB (Oxford). 2007;9(4):251-8. doi: 10.1080/13651820701457992.
Liver metastases of colorectal cancer are currently treated by multidisciplinary teams using strategies that combine chemotherapy, surgery and ablative techniques. Many patients classically considered non-resectable can now be rescued by neoadjuvant chemotherapy followed by liver resection, with similar results to those obtained in initial resections. While many of those patients will recur, repeat resection is a feasible and safe approach if the recurrence is confined to the liver. Several factors that until recently were considered contraindications are now recognized only as adverse prognostic factors and no longer as contraindications for surgery. The current evaluation process to select patients for surgery is no longer focused on what is to be removed but rather on what will remain. The single most important objective is to achieve a complete (R0) resection within the limits of safety in terms of quantity and quality of the remaining liver. An increasing number of patients with synchronous liver metastases are treated by simultaneous resection of the primary and the liver metastatic tumours. Multilobar disease can also be approached by staged procedures that combine neoadjuvant chemotherapy, limited resections in one lobe, embolization or ligation of the contralateral portal vein and a major resection in a second procedure. Extrahepatic disease is no longer a contraindication for surgery provided that an R0 resection can be achieved. A reverse surgical staged approach (liver metastases first, primary second) is another strategy that has appeared recently. Provided that a careful selection is made, elderly patients can also benefit from surgical treatment of liver metastases.
结直肠癌肝转移目前由多学科团队采用结合化疗、手术和消融技术的策略进行治疗。许多经典上被认为不可切除的患者现在可以通过新辅助化疗然后进行肝切除来挽救，其结果与初始切除相似。虽然许多患者会复发，但如果复发仅限于肝脏，再次切除是一种可行且安全的方法。以前被认为是禁忌的几个因素现在仅被认为是不良预后因素，而不再是手术的禁忌。目前选择手术患者的评估过程不再侧重于要切除什么，而是侧重于剩下什么。唯一最重要的目标是在剩余肝脏的数量和质量方面安全地实现完全（R0）切除。越来越多的同时性肝转移患者通过同时切除原发和肝转移肿瘤来治疗。多肝叶疾病也可以通过分期手术来治疗，这些手术结合新辅助化疗、一叶的有限切除、对侧门静脉栓塞或结扎以及第二次主要切除。只要可以实现 R0 切除，肝外疾病就不再是手术的禁忌。一种新出现的反向手术分期方法（肝转移灶先行，原发灶随后）也是另一种策略。只要进行仔细的选择，老年患者也可以从肝转移灶的手术治疗中获益。
