Cassar Noel, Geoghegan Justin, Hoti Emir
Department of Hepatobiliary Surgery and Liver Transplantation, St Vincent's University Hospital, Elm Park, Dublin 4 D04 T6F4, Ireland.
Department of Hepatobiliary Surgery and Liver Transplantation, St Vincent's University Hospital, Elm Park, Dublin 4 D04 T6F4, Ireland.
Surgeon. 2022 Dec;20(6):363-372. doi: 10.1016/j.surge.2021.12.005. Epub 2022 Jan 5.
Management of patients with colorectal liver metastases has evolved considerably due to a better understanding of the biology of the disease with concurrent improvements in surgical techniques, oncological strategies and radiological interventions. This review article examines the factors that have contributed to this radical change. Management will be discussed in relation to chemotherapy, surgery and interventional radiology. The addition of chemotherapy and biological agents has greatly extended the reach and scope of surgery. Parenchymal sparing resections, repeat resections, two stage hepatectomy and Associating Liver Partition and Portal Vein ligation are all available to the hepatobiliary surgeon who deals with colorectal liver metastases. Interventional radiology techniques like liver venous deprivation may also replace established surgical practice. Whilst traditionally it was thought that only a few liver metastases could be treated effectively, nowadays tumour number is no longer a limiting factor provided enough functioning liver can be spared and the patient can tolerate the operation.
由于对结直肠癌肝转移疾病生物学的更好理解，同时外科技术、肿瘤学策略和放射学干预也有所改进，结直肠癌肝转移患者的管理已经有了很大的进展。这篇综述文章探讨了促成这一根本性变化的因素。将从化疗、手术和介入放射学方面讨论管理方法。化疗和生物制剂的加入极大地扩展了手术的范围和广度。实质保留切除术、重复切除术、二期肝切除术以及联合肝脏分隔和门静脉结扎术，对于处理结直肠癌肝转移的肝胆外科医生来说都是可行的。像肝静脉阻断这样的介入放射学技术也可能取代既定的外科手术方法。传统上认为只有少数肝转移灶能够得到有效治疗，而如今只要能保留足够的有功能肝脏且患者能够耐受手术，肿瘤数量就不再是一个限制因素。
