Kitano Yuki, Hayashi Hiromitsu, Matsumoto Takashi, Kinoshita Shotaro, Sato Hiroki, Shiraishi Yuta, Nakao Yosuke, Kaida Takayoshi, Imai Katsunori, Yamashita Yo-Ichi, Baba Hideo
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan.
World J Gastrointest Surg. 2021 Aug 27;13(8):756-763. doi: 10.4240/wjgs.v13.i8.756.
Surgical resection for colorectal liver metastases (CRLM) may offer the best opportunity to improve prognosis. However, only about 20% of CRLM cases are indicated for resection at the time of diagnosis (initially resectable), and the remaining cases are treated as unresectable (initially unresectable). Thanks to recent remarkable developments in chemotherapy, interventional radiology, and surgical techniques, the resectability of CRLM is expanding. However, some metastases are technically resectable but oncologically questionable for upfront surgery. In pancreatic cancer, such cases are categorized as "borderline resectable", and their definition and treatment strategies are explicit. However, in CRLM, although various poor prognosis factors have been identified in previous reports, no clear definition or treatment strategy for borderline resectable has yet been established. Since the efficacy of hepatectomy for CRLM was reported in the 1970s, multidisciplinary treatment for unresectable cases has improved resectability and prognosis, and clarifying the definition and treatment strategy of borderline resectable CRLM should yield further improvement in prognosis. This review outlines the present status and the future perspective for borderline resectable CRLM, based on previous studies.
结直肠癌肝转移（CRLM）的手术切除可能是改善预后的最佳机会。然而，在诊断时，只有约20%的CRLM病例适合切除（初始可切除），其余病例则被视为不可切除（初始不可切除）。由于近年来化疗、介入放射学和手术技术的显著发展，CRLM的可切除性正在扩大。然而，一些转移灶在技术上可切除，但对于 upfront 手术在肿瘤学上存在疑问。在胰腺癌中，此类病例被归类为“边缘可切除”，其定义和治疗策略是明确的。然而，在CRLM中，尽管先前的报告已经确定了各种预后不良因素，但尚未建立明确的边缘可切除定义或治疗策略。自20世纪70年代报道了CRLM肝切除术的疗效以来，不可切除病例的多学科治疗提高了可切除性和预后，明确边缘可切除CRLM的定义和治疗策略应能进一步改善预后。本综述基于先前的研究概述了边缘可切除CRLM的现状和未来展望。
