Ihnát P, Ostruszka P, Vávra P, Peteja M, Zonča P
Rozhl Chir. 2018 Summer;97(10):451-454.
Multimodal approach in the management of patients with colorectal carcinoma and synchronous liver metastases allows for the application of various combinations of treatment modalities (colorectal resection, liver resection, chemotherapy, radiotherapy). The primary-first approach and simultaneous resection represent traditional strategies used because the primary tumor is thought to be the main source of subsequent metastases as well as the source of symptoms associated with local tumor progression (obstruction, perforation, colorectal bleeding). Poor long-term outcomes of traditional strategies have led to the proposal of reverse strategies (the liver-first approach and up-front hepatectomy approach). The idea behind reverse strategies is to give preference to liver resection over colorectal resection (prognosis of patients with stage IV colorectal cancer is determined mainly by the curability of liver metastases). According to available literature, reverse strategies are suitable mainly for patients with asymptomatic primary tumor. Treatment strategy for each patient should be individualized depending on the patients performance status, comorbidities, and tumor stage. In this paper, the authors offer an up-to-date review of treatment strategies for patients with colorectal carcinoma and synchronous liver metastases focusing on available data of evidence-based medicine. Key words: liver first - primary first - colorectal carcinoma - liver metastases - reverse strategies.
结直肠癌伴同时性肝转移患者的多模式治疗方法允许应用多种治疗方式的组合（结直肠切除术、肝切除术、化疗、放疗）。原发灶优先方法和同时切除是传统使用的策略，因为原发肿瘤被认为是后续转移的主要来源以及与局部肿瘤进展相关症状（梗阻、穿孔、结直肠出血）的来源。传统策略的长期不良结果导致了逆向策略（肝优先方法和 upfront 肝切除术方法）的提出。逆向策略背后的理念是优先进行肝切除而非结直肠切除（IV 期结直肠癌患者的预后主要由肝转移的可治愈性决定）。根据现有文献，逆向策略主要适用于无症状原发肿瘤的患者。每个患者的治疗策略应根据患者的体能状态、合并症和肿瘤分期进行个体化。在本文中，作者对结直肠癌伴同时性肝转移患者的治疗策略进行了最新综述，重点关注循证医学的现有数据。关键词：肝优先 - 原发灶优先 - 结直肠癌 - 肝转移 - 逆向策略
