Role of surgery in colorectal cancer liver metastases
Role of surgery in colorectal cancer liver metastases
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DOI：
10.3748/wjg.v20.i20.6113
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发表时间：
2014-05-28
影响因子：
4.3
通讯作者：
Tez, Mesut
中科院分区：
文献类型：
--
作者：
Akgul, Ozgur;Cetinkaya, Erdinc;Tez, Mesut
结直肠癌(CRC)是第三大常见癌症，约有35%-55%的结直肠癌患者在病程中会发生肝转移。手术切除是长期生存的唯一机会。手术的目标应该是切除所有组织学边缘阴性的转移瘤，同时保留足够的功能性肝实质。虽然切除仍然是长期生存的唯一机会，但治疗策略应该针对每个病例量身定做。对于原本不能切除的广泛转移的患者，药物治疗的进步，如全身化疗(CTX)，以及转移疾病外科技术的改进，随着中位存活率和治愈率的延长而改善了预后。门静脉栓塞术和术前CTX的使用也可能增加适合手术治疗的患者数量。尽管目前有多种治疗方法可供选择，但许多患者在肝切除后仍会复发。更活跃的全身性环磷酰胺类药物越来越多地被用作手术前或手术后的辅助治疗。局部肿瘤消融治疗，如微波凝固治疗和射频消融治疗，应考虑作为肝切除的辅助手段，因为切除不能处理所有的肿瘤病变。制定个体化计划，将手术和全身CTX相结合，是多学科团队的必要任务。本文的目的是探讨结直肠癌肝转移患者的不同治疗方法。(C)2014百仕登出版集团有限公司，版权所有。
Colorectal carcinoma (CRC) is the third most common cancer, and approximately 35%-55% of patients with CRC will develop hepatic metastases during the course of their disease. Surgical resection represents the only chance of long-term survival. The goal of surgery should be to resect all metastases with negative histological margins while preserving sufficient functional hepatic parenchyma. Although resection remains the only chance of long-term survival, management strategies should be tailored for each case. For patients with extensive metastatic disease who would otherwise be unresectable, the combination of advances in medical therapy, such as systemic chemotherapy (CTX), and the improvement in surgical techniques for metastatic disease, have enhanced prognosis with prolongation of the median survival rate and cure. The use of portal vein embolization and preoperative CTX may also increase the number of patients suitable for surgical treatment. Despite current treatment options, many patients still experience a recurrence after hepatic resection. More active systemic CTX agents are being used increasingly as adjuvant therapy either before or after surgery. Local tumor ablative therapies, such as microwave coagulation therapy and radiofrequency ablation therapy, should be considered as an adjunct to hepatic resection, in which resection cannot deal with all of the tumor lesions. Formulation of an individualized plan, which combines surgery with systemic CTX, is a necessary task of the multidisciplinary team. The aim of this paper is to discuss different approaches for patients that are treated due to CRC liver metastasis. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.