Carpizo Darren R, D'Angelica Michael
Division of Surgical Oncology, The Cancer Institute of New Jersey, Robert Wood-Johnson University Medical School, New Brunswick, NJ, USA.
Ann Surg Oncol. 2009 Sep;16(9):2411-21. doi: 10.1245/s10434-009-0493-6. Epub 2009 Jun 25.
Hepatic resection for metastatic colorectal cancer (CRC) with concomitant extrahepatic disease (EHD) is controversial. Earlier reports of the results of liver resection for metastatic CRC identified patients with EHD as a group with poor outcomes, suggesting that the presence of EHD was an absolute contraindication to resection. This has recently been challenged in several reports due to advances in systemic chemotherapy, surgical technique, and patient selection.
This review was restricted to published data in the English language identified by searches of MEDLINE and Pubmed databases as well as reference lists of recent review articles on subjects of surgery for metastatic colorectal cancer.
Five-year survival after resection is worse than patients with liver-only disease but approximates the survival rates seen in patients with resected liver-only metastases in the era prior to the use of modern chemotherapy. Recurrence occurs in the great majority of patients.
At this time, there appears to be a role for surgery in highly selected patients with a single site of EHD amenable to complete resection. Unlike patients with liver-only disease, however, the goals of surgery must not be viewed as potentially curative.
对于伴有肝外疾病（EHD）的转移性结直肠癌（CRC）进行肝切除术存在争议。早期关于转移性CRC肝切除术结果的报告将EHD患者确定为预后较差的一组，这表明EHD的存在是切除术的绝对禁忌证。由于全身化疗、手术技术和患者选择方面的进展，最近这一观点在几份报告中受到了挑战。
本综述仅限于通过检索MEDLINE和Pubmed数据库以及近期关于转移性结直肠癌手术主题的综述文章的参考文献列表所确定的英文发表数据。
切除术后的5年生存率低于仅患有肝脏疾病的患者，但接近在使用现代化疗之前的时代中仅切除肝脏转移灶的患者的生存率。绝大多数患者会复发。
目前，对于极少数具有单个可完全切除的EHD部位的患者，手术似乎有一定作用。然而，与仅患有肝脏疾病的患者不同，手术目标不应被视为具有潜在治愈性。
