Department of Hepatobiliary Surgery, Aintree University NHS Foundation Trust, Liverpool, UK.
Colorectal Dis. 2011 Sep;13(9):e252-65. doi: 10.1111/j.1463-1318.2011.02695.x.
The standard treatment for colorectal liver metastases (CRLM) is surgical resection. Only 20-30% of patients are deemed suitable for surgery. Recently, much attention has focused on ablative therapies either to treat unresectable CRLM or to extend the margins of resectability. This review aims to assess the long-term outcome and complication rates of various ablative therapies used in the management of CRLM.
A literature search was performed of electronic databases including Medline, Cochrane Collaboration Library and the National Library of Medicine's ClinicalTrials.gov. Inclusion criteria were ablation for CRLM with minimum 1 year follow-up and >10 patients, published between January 1994 and January 2010.
In all, 226 potentially relevant studies were identified, of which 75 met the inclusion criteria. Cryotherapy (26 studies) had local recurrence rates of 12-39%, with mean 1-, 3- and 5-year survival rates of 84%, 37% and 17%. The major complication rate ranged from 7% to 66%. Microwave ablation (13 studies) had a local recurrence rate of 5-13%, with a mean 1-, 3- and 5-year survival of 73%, 30% and 16%, and a major complication rate ranging from 3% to 16%. Radiofrequency ablation (36 studies) had a local recurrence rate of 10-31%, with a mean 1-, 3- and 5-year survival of 85%, 36% and 24%, with major complication rate ranging from 0% to 33%.
Ablative therapies offer significantly improved survival compared with palliative chemotherapy alone with 5-year survival rates of 17-24%. Complication rates amongst commonly used techniques are low.
结直肠癌肝转移（CRLM）的标准治疗方法是手术切除。只有 20-30%的患者适合手术。最近，人们越来越关注消融疗法，无论是用于治疗不可切除的 CRLM 还是扩大可切除性的范围。本综述旨在评估各种消融疗法在 CRLM 治疗中的长期疗效和并发症发生率。
对包括 Medline、Cochrane 协作图书馆和美国国立医学图书馆的 ClinicalTrials.gov 在内的电子数据库进行了文献检索。纳入标准为消融治疗 CRLM，随访时间至少 1 年，且>10 例患者，发表时间为 1994 年 1 月至 2010 年 1 月。
共确定了 226 项可能相关的研究，其中 75 项符合纳入标准。冷冻疗法（26 项研究）的局部复发率为 12-39%，平均 1、3 和 5 年生存率分别为 84%、37%和 17%。主要并发症发生率为 7%-66%。微波消融（13 项研究）的局部复发率为 5-13%，平均 1、3 和 5 年生存率分别为 73%、30%和 16%，主要并发症发生率为 3%-16%。射频消融（36 项研究）的局部复发率为 10-31%，平均 1、3 和 5 年生存率分别为 85%、36%和 24%，主要并发症发生率为 0%-33%。
与单纯姑息化疗相比，消融疗法可显著提高生存率，5 年生存率为 17-24%。常用技术的并发症发生率较低。
