Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
J Hepatobiliary Pancreat Sci. 2012 Sep;19(5):523-7. doi: 10.1007/s00534-012-0524-8.
To determine the treatment strategy for hepatic metastases of colorectal cancer, it is important to take into account whether metastases are still localized in the liver, or whether the tumor has metastasized throughout the body. For liver-limited metastasis, hepatectomy is the therapeutic strategy that offers the best prospect of improving a patient's prognosis if the case is deemed resectable. In cases when surgery is not indicated for hepatic metastases of colorectal cancer, chemotherapy is the first-choice treatment. Chemotherapy for colorectal cancer has made vast strides in recent years through advances such as the development of molecular targeted drugs. In cases where chemotherapy is effective and surgical resection becomes possible (conversion chemotherapy), the long-term prognosis may be good. The value of preoperative chemotherapy in resectable cases (neoadjuvant chemotherapy) has also been reported. The improvement in prognosis achieved by eradicating tiny latent metastases is important in conversion therapy, as well as in neoadjuvant chemotherapy. It will be important to achieve further improvements in the prognoses of patients with hepatic metastases of colorectal cancer through a combination of advances in diagnostic imaging, improvements in surgical techniques, and more effective chemotherapy treatments.
为了确定结直肠癌肝转移的治疗策略，重要的是要考虑转移是否仍局限于肝脏，或者肿瘤是否已经全身转移。对于肝局限性转移，如果病例可切除，肝切除术是改善患者预后的最佳治疗策略。对于结直肠癌肝转移不适合手术的患者，化疗是首选治疗方法。近年来，随着分子靶向药物的发展，结直肠癌的化疗取得了巨大进展。在化疗有效的情况下且手术切除成为可能（转化化疗）时，长期预后可能良好。术前化疗在可切除病例中的价值（新辅助化疗）也已得到报道。在转化治疗和新辅助化疗中，通过消除微小的潜伏转移来提高预后的价值非常重要。通过结合诊断影像学的进步、手术技术的改进和更有效的化疗治疗，提高结直肠癌肝转移患者的预后将非常重要。
