Diaz-Nieto Rafael, Fenwick Stephen, Malik Hassan, Poston Graeme
Hepatobiliary Surgery Unit, Aintree University Hospital, Liverpool, L9 7AL, UK.
Curr Treat Options Oncol. 2017 Feb;18(2):8. doi: 10.1007/s11864-017-0452-6.
The role of physical interventions (surgical resection and surgical/radiological ablation) for liver metastases of colorectal cancer has changed dramatically over the last 10-15 years. Whereas in the 1990s, when only those patients with up to three unilobar metastases were considered for any form of such intervention, our present approach to these physical interventions is determined by how much viable disease-free liver can be preserved (most authorities accepting 25-30% disease-free future remnant liver volume) and the possibility of further such interventions if the disease recurs in the liver. There is increasing evidence that for smaller tumours (<3 cm diameter), ablation therapy may be therapeutically the equivalent of surgical resection and possibly safer in high-risk patients with multiple comorbidities. Therefore, we now consider the use of such ablation therapies (with or without surgical resection) to be clinically effective when treating patients with multiple bilobar metastases that have shown good radiologic response to prior systemic therapy.
在过去10至15年中，物理干预（手术切除以及手术/放射消融）在结直肠癌肝转移治疗中的作用发生了巨大变化。在20世纪90年代，只有那些肝转移灶不超过三个且位于单叶的患者才会考虑接受任何形式的此类干预，而我们目前对于这些物理干预的选择，取决于能够保留多少有活力的无瘤肝组织（大多数权威机构认为未来剩余无瘤肝体积应为25% - 30%）以及如果肝脏疾病复发时进一步进行此类干预的可能性。越来越多的证据表明，对于较小的肿瘤（直径<3厘米），消融治疗在治疗效果上可能等同于手术切除，并且对于患有多种合并症的高危患者可能更安全。因此，我们现在认为，在治疗多叶多发转移且对先前全身治疗显示出良好放射学反应的患者时，使用此类消融治疗（无论是否联合手术切除）在临床上是有效的。
