Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany.
Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany.
J Cancer Res Clin Oncol. 2022 Mar;148(3):657-665. doi: 10.1007/s00432-021-03880-4. Epub 2021 Dec 16.
The following is an overview of the treatment strategies and the prognostic factors to consider in the therapeutic choice of patients characterized by solitary colorectal liver metastasis. Liver resection is the only potential curative option; nevertheless, only 25% of the patients are considered to be eligible for surgery. To expand the potentially resectable pool of patients, surgeons developed multidisciplinary techniques like portal vein embolization, two-stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy. Moreover, mini-invasive surgery is gaining support, since it offers lower post-operative complication rates and shorter hospital stay with no differences in long-term outcomes. In case of unresectable disease, various techniques of local ablation have been developed. Radiofrequency ablation is the most commonly used form of thermal ablation: it is widely used for unresectable patients and is trying to find its role in patients with small resectable metastasis. The identification of prognostic factors is crucial in the choice of the treatment strategy. Previous works that focused on patients with solitary colorectal liver metastasis obtained trustable negative predictive factors such as presence of lymph-node metastasis in the primary tumour, synchronous metastasis, R status, right-sided primary colon tumor, and additional presence of extrahepatic tumour lesion. Even the time factor could turn into a predictor of tumour biology as well as further clinical course, and could be helpful to discern patients with worse prognosis.
以下是孤立性结直肠肝转移患者治疗选择中需要考虑的治疗策略和预后因素概述。肝切除术是唯一有治愈可能的选择；然而，只有 25%的患者被认为有手术适应证。为了扩大潜在可切除患者的群体，外科医生开发了多学科技术，如门静脉栓塞术、两阶段肝切除术或联合肝分区和门静脉结扎分期肝切除术。此外，微创外科正在得到支持，因为它具有较低的术后并发症发生率和较短的住院时间，而在长期结果方面没有差异。对于不可切除的疾病，已经开发了各种局部消融技术。射频消融是最常用的热消融形式：它广泛用于不可切除的患者，并试图在有小可切除转移的患者中找到其作用。预后因素的确定对治疗策略的选择至关重要。以前专注于孤立性结直肠肝转移患者的研究获得了可靠的阴性预测因素，如原发肿瘤中淋巴结转移、同步转移、R 状态、右半结肠肿瘤和额外的肝外肿瘤病变。即使时间因素也可能成为肿瘤生物学以及进一步临床过程的预测因素，并有助于区分预后较差的患者。
