Divisions of Transplantation and Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland.
Semin Liver Dis. 2013 Aug;33(3):262-72. doi: 10.1055/s-0033-1351785. Epub 2013 Aug 13.
In this review, the authors describe the management of patients with colorectal liver metastases in the era of effective chemotherapies and advanced interventional radiology. They give special attention to the surgical procedures that decrease the operative mortality and morbidity and produce clear margins. They discuss the best timing for chemotherapy, resection of the primary tumor, and resection of the liver metastases in an effort to improve long-term survival. The use of preoperative portal vein embolization, two-stage hepatectomy for bilobar synchronous liver metastases, and the liver-first strategy have allowed for treatment of patients with advanced disease with a curative intent, and to obtain 5-year overall survival of 30 to 60% despite poor prognostic factors and a cure (no recurrence at 10 years) in more than 20% of patients. These rates would have been unimaginable only two decades ago.
在这篇综述中，作者描述了在有效的化疗和先进的介入放射学时代，结直肠癌肝转移患者的治疗方法。他们特别关注那些降低手术死亡率和发病率并产生明确切缘的手术操作。他们讨论了化疗、原发肿瘤切除和肝转移切除的最佳时机，以提高长期生存率。术前门静脉栓塞、两阶段肝切除术治疗双侧同步肝转移和肝优先策略，使得治疗具有晚期疾病的患者具有治愈意图，并获得 30%至 60%的 5 年总生存率，尽管存在预后不良因素，并且超过 20%的患者在 10 年内无复发（治愈）。仅在二十年前，这些比率是难以想象的。
