Xu J M, Zhu D X, Ren L
Department of Colorectal Surgery, Colorectal Cancer Center, Zhongshan Hospital, Institute of General Surgery, Fudan University, Shanghai 200032, China.
Zhonghua Wai Ke Za Zhi. 2017 Jul 1;55(7):491-495. doi: 10.3760/cma.j.issn.0529-5815.2017.07.003.
Surgical resection of the metastases offers the only opportunity for long-term survival in colorectal liver metastases. However, only 10% to 20% of patients present with resectable disease, and so how to increase surgical patients has been a clinical hotspot. In addition to expanding surgical indications, two-stage hepatectomy and convertible therapy are optional. In convertible therapy, initial treatment regimen decides long-term benefit, and it is important to select appropriate patient population in addition to Ras status when anti-epithelial growth factor receptor monoclonal antibody is used. Minimally invasive surgery can also be used for liver resection and simultaneous resection, and it is safe and effective. For patients with colorectal cancer and unresectable asymptomatic liver metastases, the debate continues over the efficacy of primary resection compared to chemotherapy alone, limited by lack of prospective evidence. Therefore, multidisciplinary team assessment is essential to optimize outcomes in colorectal liver metastases.
手术切除转移灶是结直肠癌肝转移患者获得长期生存的唯一机会。然而,只有10%至20%的患者存在可切除的病灶,因此如何增加可手术患者一直是临床热点。除了扩大手术指征外,两阶段肝切除术和转化治疗也是可选方案。在转化治疗中,初始治疗方案决定长期获益,在使用抗表皮生长因子受体单克隆抗体时,除了Ras状态外,选择合适的患者群体也很重要。微创手术也可用于肝切除和同期切除,且安全有效。对于患有结直肠癌和不可切除无症状肝转移的患者,由于缺乏前瞻性证据,关于原发灶切除与单纯化疗疗效的争论仍在继续。因此,多学科团队评估对于优化结直肠癌肝转移的治疗效果至关重要。