Heinrich S, Lang H
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55130, Mainz, Deutschland.
Chirurg. 2014 Jan;85(1):17-23. doi: 10.1007/s00104-013-2565-1.
Approximately 50 % of patients with colorectal cancer (CRC) develop liver metastases, with the liver being the only site of metastasis in the majority of patients. Liver resection is the standard treatment of CRC liver metastases as it achieves a 5-year survival of 36-51 %. The primary goal in the treatment of non-resectable liver metastases is to achieve resectability by preoperative chemotherapy as even secondary liver resection after down-sizing is associated with improved overall survival. Furthermore, resectability can be increased by two-stage surgical procedures; however, the assessment of resectability varies widely even among experts in the field. In cases of suspected non-resectability patients should therefore be liberally admitted for a second opinion to centers of liver surgery. Perioperative chemotherapy in primarily resectable cases has only demonstrated an improvement in recurrence-free survival in subgroup analyses. Moreover, modern potent chemotherapy regimens increase the surgical morbidity depending on the duration of treatment: the lower the histological response of the metastases and the more treatment cycles are applied, the higher is the parenchymal damage with related surgical morbidity. Therefore, perioperative chemotherapy of resectable liver metastases should be viewed with caution and should not be considered the standard of care.
约50%的结直肠癌（CRC）患者会发生肝转移，在大多数患者中肝脏是唯一的转移部位。肝切除是CRC肝转移的标准治疗方法，其5年生存率为36% - 51%。不可切除肝转移瘤治疗的主要目标是通过术前化疗实现可切除性，因为即使在肿瘤缩小后进行二期肝切除也与总体生存率的提高相关。此外，两阶段手术程序可提高可切除性；然而，即使在该领域的专家中，可切除性的评估也存在很大差异。因此，对于疑似不可切除的病例，应将患者广泛转诊至肝脏外科中心以获取第二种意见。在主要可切除的病例中，围手术期化疗仅在亚组分析中显示无复发生存率有所改善。此外，现代强效化疗方案会根据治疗持续时间增加手术并发症：转移灶的组织学反应越低且应用的治疗周期越多，实质损伤及相关手术并发症就越高。因此，对于可切除肝转移瘤的围手术期化疗应谨慎看待，不应被视为标准治疗方法。
