Management of colorectal liver metastases.
Management of colorectal liver metastases.
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DOI：
10.1046/j.1463-1318.2003.00410.x
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发表时间：
2003-01-01
期刊：
影响因子：
--
通讯作者：
Davidson, B R
中科院分区：
文献类型：
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作者：
Fusai, G;Davidson, B R
结直肠癌切除后60%的患者发生肝转移。肝切除是唯一的治愈选择，三分之一的切除患者可以在五年内存活。对于那些在切除后出现肝脏复发的患者，进一步的肝脏手术可能是治愈的，类似的5年生存率约为30%。直到最近，只有15%-25%的结直肠癌肝转移患者的手术是可行的。降期化疗、门静脉栓塞术和二期肝切除术等新策略可能会使切除率提高15%。及早发现肝转移将增加可切除性，尽管缺乏良好的后续试验。一旦怀疑结直肠癌肝转移，螺旋CT、CT门静脉造影和MRI都有相似的总体准确性。在主要中心，肝切除后的死亡率不到5%，发病率为20%至50%。预后评分系统可以用来预测切除后可能的治愈率。切除的结直肠癌患者中有10%-25%会发生肺转移，但仅有2%的病例局限于肺部。在这些选定的病例中，手术提供了20%-40%的长期存活率，再次肺切除的比率也相似。对于不能切除的疾病患者，化疗和消融技术已经被证明可以延长生存时间，尽管单靠化疗已经被证明可以提高生活质量。
Hepatic metastases occur in 60% of patients following resection for colorectal cancer. Liver resection is the only curative option, with one third of resected patients alive at five years. In those developing recurrence in the liver following resection, further liver surgery may be curative, with similar 5 years survival rates of about 30%. Until recently surgery was feasible in only 15-25% of patients with colorectal liver metastases. New strategies, such as downstaging chemotherapy, portal vein embolization and two-stage hepatectomy, may increase the resectability rate by 15%. Earlier detection of liver metastases would increase resectability, although good follow-up trials are lacking. Once suspected, colorectal liver metastases are staged by spiral CT, CT portography and MRI, which have similar overall accuracies. Mortality following liver resection is less than 5% in major centres, with a morbidity rate of 20% to 50%. Prognostic scoring systems can be used to predict the likely cure rate with resection. Pulmonary metastases occur in 10-25% of patients with resected colorectal cancer, but are limited to the lung in only 2% of cases. In these selected cases surgery provides long-term survival in 20-40%, and repeat lung resection has shown similar rates. For patients with unresectable disease, chemotherapy and ablation techniques have been demonstrated to prolong survival, although chemotherapy alone has been shown to improve quality of life.