Department of Transplantation Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Surgery and Division of Abdominal Transplantation and Hepatobiliary Surgery, University of Rochester Medical Center, Rochester, USA.
Int J Surg. 2020 Oct;82S:87-92. doi: 10.1016/j.ijsu.2020.03.079. Epub 2020 Apr 17.
Adenocarcinoma of the colon and rectum (CRC) is the second leading cause of cancer mortality, driven by stage IV disease (Rahib et al., 2014) [1]. While surgical resection of liver metastases has demonstrated a survival advantage, a minority of patients are candidates for resection due to anatomic involvement of disease. Recent advances in liver surgery, chemotherapy, and decision making guided by stratification at the time of presentation has better equipped us to perform aggressive metastasectomies, with resulting improved survival (Fong et al., 1999; Abdalla et al., 2001; Cremolini et al., 2017) [2-4]. As a result, there is a resurgent interest in the concept of total hepatectomy and liver transplantation (LT) for colorectal liver metastases (CRLM). As of this writing, eight prospective clinical trials in six countries are assessing the viability of split or whole LT for CRLM. However, LT for CRLM remains controversial. Recent prospective trials have illustrated the importance of patient selection, and a disciplined respect for tumor biology. Here we present the current status of LT for CRLM, and suggest clinical decision criteria aimed at matching survival benefit comparable to other indications for LT.
结直肠癌（CRC）的腺癌是癌症死亡的第二大主要原因，这主要是由 IV 期疾病驱动的（Rahib 等人，2014）[1]。虽然肝转移灶的手术切除已经显示出生存优势，但由于疾病的解剖学累及，只有少数患者适合进行切除。最近在肝外科手术、化疗以及在呈现时分层指导的决策方面的进展使我们能够更积极地进行转移灶切除术，从而提高了生存率（Fong 等人，1999；Abdalla 等人，2001；Cremolini 等人，2017）[2-4]。因此，人们对结直肠癌肝转移的全肝切除术和肝移植（LT）的概念重新产生了兴趣。截至撰写本文时，六个国家的八项前瞻性临床试验正在评估结直肠癌肝转移的 LT 可行性。然而，LT 治疗结直肠癌肝转移仍然存在争议。最近的前瞻性试验说明了患者选择的重要性，以及对肿瘤生物学的严格尊重。在这里，我们介绍了 LT 治疗结直肠癌肝转移的现状，并提出了临床决策标准，旨在使生存获益与 LT 的其他适应证相匹配。
