Hackl C, Brunner S M, Schmidt K M, Schlitt H J
Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Deutschland.
Chirurg. 2018 Mar;89(3):191-196. doi: 10.1007/s00104-017-0583-0.
Extensive, bilobular and multifocal colorectal liver metastases (CLM) or metastases that are critically situated require an experienced surgeon and advanced surgical techniques to enable curative resection.
This article describes the toolbox of hepato-oncologic surgery including functional augmentation of liver segments by portal vein embolization/ligation, combinations of ablation and resection, two-stage resections and in situ split liver resection, also known as associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Furthermore, the curative resection of extrahepatic, oligometastatic disease are briefly discussed.
Review of current literature as well as discussion of the ALPPS procedure, which was developed at our institute.
In recent years, oncologic resections for CLM have been significantly refined, leading to a constant increase of curative resection rates.
In a multimodality treatment setting, surgical resection of CLM remains the gold standard curative approach and even in the event of presumed hopeless cases with extensive metastasis, experienced hepatobiliary surgeons must evaluate the resectability of colorectal metastases.
广泛的、双叶和多灶性结直肠癌肝转移（CLM）或位置关键的转移灶需要经验丰富的外科医生和先进的手术技术才能实现根治性切除。
本文介绍了肝脏肿瘤外科的工具包，包括通过门静脉栓塞/结扎对肝段进行功能增强、消融与切除相结合、两阶段切除和原位肝分割切除，即联合肝脏分割和门静脉结扎分期肝切除术（ALPPS）。此外，还简要讨论了肝外寡转移病灶的根治性切除。
回顾当前文献，并讨论我院开展的ALPPS手术。
近年来，CLM的肿瘤切除手术有了显著改进，根治性切除率持续提高。
在多模式治疗背景下，CLM的手术切除仍然是根治性治疗的金标准，即使是在出现广泛转移的看似无望的病例中，经验丰富的肝胆外科医生也必须评估结直肠癌转移灶的可切除性。
