Department of Surgery, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2010 Sep;39(9):719-15.
Metastatic disease to the liver in colorectal cancer is a common entity that may present synchronously or metachronously. While increasing surgical experience has improved survival outcomes, some evidence suggest that synchronous lesions should be managed differently. This review aims to update current literature on differences between the outcomes and management of synchronous and metachronous disease.
Systematic review of MEDLINE database up till November 2008.
Discrete differences in tumour biology have been identified in separate studies. Twenty-one articles comparing outcomes were reviewed. Definitions of metachronicity varied from anytime after primary tumour evaluation to 1 year after surgery for primary tumour. Most studies reported that synchronous lesions were associated with poorer survival rates (8% to 16% reduction over 5 years). Sixteen articles comparing combined vs staged resections for synchronous tumour showed comparable morbidity and mortality. Benefits over staged resections included shorter hospital stays and earlier initiation of chemotherapy. Suitability for combined resection depended on patient age and constitution, primary tumour characteristics, size and the number of liver metastases, and the extent of liver involvement.
Surgery remains the only treatment option that offers a chance of long-term survival for patients amenable to curative resection. Synchronicity suggests more aggressive disease although a unifying theory for biological differences explaining the disparity in tumour behaviour has not been found. Combined resection of primary tumour and synchronous metastases is a viable option pending careful patient selection and institutional experience. Given the current evidence, management of synchronous and metachronous colorectal liver metastases needs to be individualised to the needs of each patient.
结直肠癌肝转移是一种常见的疾病，可表现为同时性或异时性。尽管外科经验的增加改善了生存结果，但一些证据表明，同时性病变的处理应该有所不同。本综述旨在更新关于结直肠癌肝转移的同时性和异时性疾病的结局和处理之间差异的现有文献。
对截至 2008 年 11 月 MEDLINE 数据库进行系统回顾。
在单独的研究中已经确定了肿瘤生物学的离散差异。共回顾了 21 篇比较结局的文章。异时性的定义从原发肿瘤评估后任何时间到原发肿瘤手术后 1 年不等。大多数研究报告同时性病变与较低的生存率相关（5 年内降低 8%至 16%）。16 篇比较同时性肿瘤联合与分期切除的文章显示，两者的发病率和死亡率相当。联合切除的益处包括较短的住院时间和更早开始化疗。联合切除的适应证取决于患者的年龄和体质、原发肿瘤特征、肝转移的大小和数量以及肝受累的程度。
手术仍然是唯一的治疗选择，为适合根治性切除的患者提供长期生存的机会。同步性提示疾病更具侵袭性，尽管尚未找到解释肿瘤行为差异的生物学差异的统一理论。在仔细选择患者和机构经验的前提下，联合切除原发肿瘤和同时性转移是一种可行的选择。鉴于目前的证据，结直肠癌肝转移的同时性和异时性的处理需要根据每个患者的需求进行个体化。
