Department of Hepatobiliary Surgery and Liver Transplantation, St. Vincent's University Hospital, Dublin, Ireland.
Department of Surgery and Transplantation, University Medical Center Schleswig-Holstein, Campus Kiel, Germany.
Surgery. 2021 Dec;170(6):1732-1740. doi: 10.1016/j.surg.2021.06.033. Epub 2021 Jul 22.
Only a few decades ago, the opinion that colorectal liver metastases were a palliative diagnosis changed. In fact, previously, the prevailing view was strongly resistant against resecting colorectal liver metastases. Constant technical improvement of liver surgery and, much later, effective chemotherapy allowed for a successful wider application of surgery. The clinical use of portal vein embolization was the starting signal of regenerative liver surgery, where insufficient liver volume can be expanded to an extent where safe resection is possible. Today, a number of these techniques including portal vein ligation, associating liver partition and portal vein ligation for staged hepatectomy, and bi-embolization (portal and hepatic vein) can be successfully used to address an insufficient future liver remnant in staged resections. It turned out that the road to success is embedding surgery in a well-orchestrated oncological concept of controlling systemic disease. This concept was the prerequisite that meant liver transplantation could enter the treatment strategy for colorectal liver metastases, ending up with a 5-year overall survival of 80% in highly selected cases. In particular, techniques combining principles of 2-stage hepatectomy and liver transplantation, such as "resection and partial liver segment 2-3 transplantation with delayed total hepatectomy" (RAPID) are on the rise. These techniques enable the use of partial liver grafts with primarily insufficient liver volume. All this progress also prompted a number of innovative local therapies to address recurrences ultimately transferring colorectal liver metastases from instantly deadly into a chronic disease in some cases.
仅在几十年前,结直肠肝转移被认为是一种姑息性诊断的观点发生了变化。事实上,之前人们普遍强烈反对切除结直肠肝转移。肝外科技术的不断进步,以及后来有效的化疗,使得手术的广泛应用成为可能。门静脉栓塞术的临床应用是再生肝切除术的开始信号,在这种手术中,可以将肝体积不足的部位扩大到可以安全切除的程度。如今,包括门静脉结扎术、联合肝脏分隔和门静脉结扎分期肝切除术以及双栓塞术(门静脉和肝静脉)在内的许多技术可成功用于分期切除中解决肝体积不足的问题。事实证明,成功的关键在于将手术嵌入系统控制疾病的综合肿瘤学概念中。这一概念是使肝移植能够进入结直肠肝转移治疗策略的前提条件,使得高度选择的病例 5 年总生存率达到 80%。特别是结合 2 期肝切除术和肝移植原则的技术,如“切除和部分肝段 2-3 移植伴延迟性全肝切除术”(RAPID)的应用正在增加。这些技术使原本肝体积不足的部分肝移植物得以使用。所有这些进展也促使了一些创新的局部治疗方法来解决复发问题,最终使结直肠肝转移在某些情况下从即刻致命转变为慢性疾病。
World J Gastrointest Oncol. 2025-1-15
J Cancer Res Clin Oncol. 2023-9
Ann R Coll Surg Engl. 2024-3
J Gastrointest Oncol. 2022-10
Medicina (Kaunas). 2022-10-10