Department of Surgery, Westmead Hospital, Wentworthville, NSW, Australia.
Ann Surg Oncol. 2012 Apr;19(4):1292-301. doi: 10.1245/s10434-011-2061-0. Epub 2011 Sep 16.
Selected patients with unresectable colorectal liver metastases (CLM) may be rendered resectable after systemic chemotherapy. We reviewed the evidence of downsizing systemic chemotherapy followed by rescue liver surgery in patients with initially unresectable CLM.
Literature search of databases (Medline and PubMed) to identify published studies of neoadjuvant chemotherapy followed by liver resection in patients with initially unresectable CLM was undertaken and focused on response rate of chemotherapy and survival outcomes.
Ten observational studies were reviewed. A total of 1,886 patients with initially unresectable CLM underwent systemic chemotherapy. An objective response was observed in 64% (range, 43-79%) of patients after systemic chemotherapy. Of these, 22.5% underwent macroscopically curative liver resection. Median overall survival was 45 (range, 36-60) months with 19% of patients alive and recurrence-free.
Current evidence suggests that downsizing systematic chemotherapy followed by rescue liver resection is safe and effective for selected patients with initially unresectable CLM. Further studies are required to examine response rates and secondary resectability using new targeted molecular therapy-based regimens.
对于不可切除的结直肠癌肝转移（CLM）患者，全身化疗后可能会使部分患者获得可切除性。我们回顾了全身化疗使初始不可切除的 CLM 患者降期后行挽救性肝切除术的证据。
检索数据库（Medline 和 PubMed）中的文献，以确定对初始不可切除的 CLM 患者行新辅助化疗后行肝切除术的研究，并重点关注化疗的反应率和生存结果。
共回顾了 10 项观察性研究。共 1886 例初始不可切除的 CLM 患者接受了全身化疗。全身化疗后，64%（范围为 43%79%）的患者观察到客观缓解。其中，22.5%的患者行根治性肝切除术。中位总生存期为 45（范围为 3660）个月，19%的患者无瘤生存。
目前的证据表明，对初始不可切除的 CLM 患者进行全身化疗降期后行挽救性肝切除术是安全有效的。需要进一步研究使用新的基于靶向分子治疗的方案来评估反应率和二次可切除性。
