Folprecht G, Bechstein W O
Universitätskrebszentrum/Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland.
Chirurg. 2011 Nov;82(11):989-94. doi: 10.1007/s00104-011-2131-7.
The resection of liver metastases offers the option of long-term survival for patients with colorectal carcinoma. With regard to resectability three clinical situations can be identified: patients with resectable liver metastases, those with potentially resectable liver metastases and patients with disseminated metastatic disease. Patients with potentially resectable liver metastases should be treated with regimens with high response rates. According to a metaanalysis patients with resectable liver metastases have a better disease-free survival with the combination of resection and chemotherapy. If neoadjuvant therapy is planned in resectable patients the FOLFOX regimen is the schedule with the highest level of evidence. In potentially resectable liver metastases the regimens FOLFIRI/cetuximab and FOLFOXIRI have demonstrated higher response and resection rates in phase III trials. During neoadjuvant therapy resectability should be regularly reevaluated. Operations should be planned as soon as resectability is achieved because a longer therapy will increase morbidity and because of uncertainty over the approach to patients with complete remission.
肝转移瘤切除术为结直肠癌患者提供了长期生存的选择。关于可切除性，可识别出三种临床情况：可切除肝转移瘤患者、潜在可切除肝转移瘤患者和弥漫性转移性疾病患者。潜在可切除肝转移瘤患者应接受具有高缓解率的治疗方案。根据一项荟萃分析，可切除肝转移瘤患者采用手术切除与化疗相结合的方法，无病生存期更佳。如果计划对可切除患者进行新辅助治疗，FOLFOX方案是证据级别最高的治疗方案。在潜在可切除肝转移瘤患者中，FOLFIRI/西妥昔单抗和FOLFOXIRI方案在III期试验中显示出更高的缓解率和切除率。在新辅助治疗期间，应定期重新评估可切除性。一旦实现可切除性，就应尽快安排手术，因为更长时间的治疗会增加发病率，并且对于完全缓解的患者，治疗方法存在不确定性。
