Tsoulfas Georgios, Pramateftakis Manousos-Georgios
1st Surgical Department, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56429 Thessaloniki, Greece.
Int J Surg Oncol. 2012;2012:196908. doi: 10.1155/2012/196908. Epub 2012 Jun 20.
In the last few decades there have been significant changes in the approach to rectal cancer management. A multimodality approach and advanced surgical techniques have led to an expansion of the treatment of metastatic disease, with improved survival. Hepatic metastases are present at one point or another in about 50% of patients with colorectal cancer, with surgical resection being the only chance for cure. As the use of multimodality treatment has allowed the tackling of more complicated cases, one of the main questions that remain unanswered is the management of patients with synchronous rectal cancer and hepatic metastatic lesions. The question is one of priority, with all possible options being explored. Specifically, these include the simultaneous rectal cancer and hepatic metastases resection, the rectal cancer followed by chemotherapy and then by the liver resection, and finally the "liver-first" option. This paper will review the three treatment options and attempt to dissect the indications for each. In addition, the role of laparoscopy in the synchronous resection of rectal cancer and hepatic metastases will be reviewed in order to identify future trends.
在过去几十年里，直肠癌的治疗方法发生了重大变化。多模式治疗方法和先进的手术技术使得转移性疾病的治疗范围得以扩大，患者生存率得到提高。大约50%的结直肠癌患者在某个阶段会出现肝转移，手术切除是唯一的治愈机会。由于多模式治疗的应用使得能够处理更复杂的病例，一个尚未得到解答的主要问题是同时患有直肠癌和肝转移瘤的患者的治疗管理。这是一个优先级问题，目前正在探索所有可能的选择。具体来说，这些选择包括同时进行直肠癌和肝转移灶切除、先进行直肠癌化疗然后再进行肝切除，以及最后的“肝优先”方案。本文将回顾这三种治疗选择，并试图剖析每种选择的适应症。此外，还将回顾腹腔镜在直肠癌和肝转移灶同步切除中的作用，以确定未来的发展趋势。
