Colorectal liver metastases: Current management and future perspectives.
Colorectal liver metastases: Current management and future perspectives.
复制标题
结直肠肝转移：目前的管理和未来的前景。
DOI：
10.5306/wjco.v11.i10.761
复制
发表时间：
2020-10-24
影响因子：
2.8
通讯作者：
Huguet E
中科院分区：
文献类型：
--
作者：
Martin J;Petrillo A;Smyth EC;Shaida N;Khwaja S;Cheow HK;Duckworth A;Heister P;Praseedom R;Jah A;Balakrishnan A;Harper S;Liau S;Kosmoliaptsis V;Huguet E
肝脏是结直肠癌患者最常见的转移部位，至少25%的患者在发病过程中发生结直肠肝转移（CRLM）。CRLM的管理已经发展成为一个复杂的领域，需要有经验的多学科团队成员的投入，包括放射学（横断面、核医学和介入）、肿瘤学、肝脏外科、结直肠外科和组织病理学。患者管理是基于复杂的临床，放射学和生物标志物信息的评估。尽管在这一异质性非常大的患者群体中证据不完整，但使用所有可用技术最大限度地切除CRLM仍然是一个关键目标，并提供了长期生存和治愈的最佳机会。为此，在改善未来残肝功能评估的背景下，肝切除可通过使用小剂量化疗、门静脉栓塞优化残肝、肝分区和门静脉结扎联合分阶段肝切除术、切除与消融相结合来最大化。肝脏切除术可以在腹腔镜下或开腹手术中安全地进行，并与结直肠手术同时进行，或在结直肠手术之前进行。对于无法切除的患者，治疗方案包括全身化疗、靶向生物制剂、动脉内输注或头部化疗、肿瘤消融、立体定向放疗和选择性内放疗有助于提高生存率，并可能使最初无法切除的患者转为可操作性。目前正在发展的领域包括肿瘤的生物标志物特征，针对特定致癌途径的新型全身药物的开发，以及可能重新出现的根治性手术选择，如肝移植。
The liver is the commonest site of metastatic disease for patients with colorectal cancer, with at least 25% developing colorectal liver metastases (CRLM) during the course of their illness. The management of CRLM has evolved into a complex field requiring input from experienced members of a multi-disciplinary team involving radiology (cross sectional, nuclear medicine and interventional), Oncology, Liver surgery, Colorectal surgery, and Histopathology. Patient management is based on assessment of sophisticated clinical, radiological and biomarker information. Despite incomplete evidence in this very heterogeneous patient group, maximising resection of CRLM using all available techniques remains a key objective and provides the best chance of long-term survival and cure. To this end, liver resection is maximised by the use of downsizing chemotherapy, optimisation of liver remnant by portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy, and combining resection with ablation, in the context of improvements in the functional assessment of the future remnant liver. Liver resection may safely be carried out laparoscopically or open, and synchronously with, or before, colorectal surgery in selected patients. For unresectable patients, treatment options including systemic chemotherapy, targeted biological agents, intra-arterial infusion or bead delivered chemotherapy, tumour ablation, stereotactic radiotherapy, and selective internal radiotherapy contribute to improve survival and may convert initially unresectable patients to operability. Currently evolving areas include biomarker characterisation of tumours, the development of novel systemic agents targeting specific oncogenic pathways, and the potential re-emergence of radical surgical options such as liver transplantation.
影响因子：
8.8
作者：
Auvinen, A.;Isola, J.;Visakorpi, T.;Koivula, T.;Virtanen, S.;Hakama, M.
通讯作者：
Hakama, M.
结直肠肿瘤的 p53 蛋白含量增加与生存率低相关。
影响因子：
8.8
作者：
Remvikos, Y;Tominaga, O;Hammel, P;Laurent-Puig, P;Salmon, R J;Dutrillaux, B;Thomas, G
通讯作者：
Thomas, G