Department of Hepatopancreatobiliary and Transplantation Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, England.
Surg Oncol. 2011 Jun;20(2):57-72. doi: 10.1016/j.suronc.2009.10.002. Epub 2009 Dec 3.
Liver resection remains the only chance of cure for patients with colorectal liver metastasis. Modern chemotherapy can play a role in the management of these patients but is not without risk.
The online databases Medline and Pubmed were searched to identify relevant articles. Keywords used in these searches were "colorectal cancer", "liver metastasis", "chemotherapy", "liver resection", "monoclonal antibody", "steatohepatitis", "sinusoidal obstruction" and "liver regeneration". Databases were searched for the period January 1970 to September 2009 inclusively. In addition hand referencing of retrieved articles was performed.
Modern chemotherapy regimens can effectively downstage initially unresectable disease such that surgical resection can be performed with the prospect of long term cure. There is insufficient evidence however to recommend its use in either the neoadjuvant or adjuvant setting in those with resectable disease from the outset.
Chemotherapy can be associated with significant changes to the hepatic parenchyma with subsequent increased risk of morbidity and mortality in the perioperative period. Much work needs to be done to understand the molecular mechanisms underlying these changes to make extended resections safer in patients who are at risk.
肝切除术仍然是结直肠癌肝转移患者获得治愈的唯一机会。现代化疗在这些患者的治疗中可以发挥作用，但并非没有风险。
在线数据库 Medline 和 Pubmed 进行了检索，以确定相关文章。这些搜索中使用的关键词是“结直肠癌”、“肝转移”、“化疗”、“肝切除术”、“单克隆抗体”、“脂肪性肝炎”、“窦状隙阻塞”和“肝再生”。数据库检索的时间范围为 1970 年 1 月至 2009 年 9 月。此外，还对检索到的文章进行了手工引用。
现代化疗方案可以有效地降期初始不可切除的疾病，使手术切除可以进行长期治愈的前景。然而，没有足够的证据表明在有可切除疾病的患者中，无论是新辅助还是辅助治疗中都可以使用。
化疗可能导致肝实质发生显著变化，从而导致围手术期发病率和死亡率增加。为了使高危患者的扩大切除术更安全，需要做大量工作来了解这些变化的分子机制。
