Gustavsson Bengt
Department of Surgery, University of Gothenburg, Sahlgrenska University Hospital/Östra Institute of Clinical Sciences, Göteborg, Sweden.
Scand J Gastroenterol. 2012 Mar;47(3):269-76. doi: 10.3109/00365521.2012.640824. Epub 2012 Jan 16.
Approximately 20-25% of patients with colorectal cancer present with liver metastases at the time of diagnosis. Traditionally, resection of the primary tumor has been advocated in order to prevent complications of the primary tumor colorectal cancer in patients with synchronous liver metastases. The published data concerning long-term prognosis in this group of patients are discordant. Although some of the reports show survival benefits from resection of the primary tumor, these studies are retrospective with small number of patients and using single drug chemotherapy. For patients with resectable liver metastases, new studies indicate that progression-free survival is best in patients receiving perioperative chemotherapy. In patients with synchronous nonresectable liver metastases and colorectal cancer, there is no published prospective randomized study comparing initial surgery of the primary tumor with neoadjuvant chemotherapy. However, recent publications show that in patients receiving chemotherapy based on oxaliplatin or irinotecan combined with targeted treatments, the complications associated with the primary tumor are less than 10%. The conclusion should be that today prophylactic surgery of asymptomatic primary colorectal cancer in patients with liver metastases cannot be recommended.
约20%-25%的结直肠癌患者在诊断时已出现肝转移。传统上，为预防同时性肝转移患者原发性结直肠癌的并发症，一直提倡切除原发性肿瘤。关于这组患者长期预后的已发表数据并不一致。虽然一些报告显示切除原发性肿瘤可带来生存益处，但这些研究是回顾性的，患者数量少且使用单一药物化疗。对于可切除肝转移的患者，新研究表明接受围手术期化疗的患者无进展生存期最佳。对于同时性不可切除肝转移和结直肠癌的患者，尚无已发表的前瞻性随机研究比较原发性肿瘤的初始手术与新辅助化疗。然而，最近的出版物表明，在接受基于奥沙利铂或伊立替康联合靶向治疗的化疗的患者中，与原发性肿瘤相关的并发症不到10%。结论应该是，如今不建议对有肝转移的无症状原发性结直肠癌患者进行预防性手术。
