Papaconstantinou Dimitrios, Pararas Nikolaos, Pikouli Anastasia, Nastos Constantinos, Charalampopoulos Anestis, Dellaportas Dionysios, Bagias George, Pikoulis Emmanouil
Third Department of Surgery, Attikon University Hospital, 15772 Athens, Greece.
Cancers (Basel). 2023 Mar 31;15(7):2083. doi: 10.3390/cancers15072083.
Liver resection for colorectal liver metastases (CRLM) is widely considered the treatment with the highest curative potential. However, not all patients derive the same oncological benefit, underlining the need for better patient stratification and treatment allocation. In this context, we performed a systematic review of the literature to determine the role of RAS status in selecting the optimal surgical strategy. Evidence comparing anatomical with non-anatomical resections depending on RAS mutational status was scarce and conflicting, with two studies reporting superiority in mutated RAS (mutRAS) patients and two studies reporting equivalent outcomes. The rate of incomplete microscopic resection (R1) was found to be increased among mutRAS patients, possibly due to higher micrometastatic spread lateral to the primary lesion. The impact of R1 resection margins was evaluated separately for mutRAS and wild-type patients in three studies, of which, two indicated an additive detriment to long-term survival in the former group. In the current era of precision surgery, RAS status can be utilized to predict the efficacy of liver resection in the treatment of CRLM, avoiding a potentially morbid operation in patients with adverse tumor profiles.
肝切除治疗结直肠癌肝转移（CRLM）被广泛认为是最具治愈潜力的治疗方法。然而，并非所有患者都能获得相同的肿瘤学益处，这凸显了更好地进行患者分层和治疗分配的必要性。在此背景下，我们对文献进行了系统综述，以确定RAS状态在选择最佳手术策略中的作用。根据RAS突变状态比较解剖性切除与非解剖性切除的证据稀少且相互矛盾，两项研究报告突变型RAS（mutRAS）患者具有优势，两项研究报告结果相当。发现mutRAS患者中不完全微观切除（R1）率增加，这可能是由于原发灶外侧更高的微转移扩散所致。三项研究分别评估了R1切缘对mutRAS和野生型患者的影响，其中两项表明前一组对长期生存有额外的不利影响。在当前的精准手术时代，RAS状态可用于预测肝切除治疗CRLM的疗效，避免对肿瘤特征不良的患者进行潜在的高风险手术。
