结直肠癌肝转移转化治疗后手术时机及术式选择

Operation time of colorectal liver metastasis and choice of operation after convertible therapy

肝脏是结直肠癌最常见的转移部位,手术切除是惟一可能治愈的方法,通过积极的转化治疗可以使一部分不可切除的肝转移病灶转化为可切除,并获得良好的生存。基于转化治疗后肝切除预后与转化治疗的线数、疗程等有关,多程化疗后带来的肝脏毒性及术后并发症增加等情况,建议在高强度、高效化疗适当疗程后,肿瘤退缩至符合可切除标准即可。关于最佳手术方式、同期肝转移原发灶与转移灶处理先后顺序问题,目前没有定论,建议由多学科综合治疗团队根据具体情况制定个体化的治疗方案。

Colorectal cancer （CRC） is a very common malignancy and frequently manifests with liver metastases. Resection of liver-limited metastases from CRC has become the standard of care. Chemotherapy is effective in converting some unresectable liver metastases into resectable disease, with a correspondingly better survival outcome. If neoadjuvant chemotherapy is given, the intention is to provide maximal shrinkage of liver lesions to facilitate surgery as well as to control micrometastatic disease. Ideally, the duration of treatment would be long enough to maximize response but short enough to minimize toxicity and surgical morbidity. Some groups advocate that synchronous metastatic disease should be resected at the same time as the primary, whereas others believe that outcomes are better following delayed resection for metastatic disease, and others advocated a liver first approach. Patients with liver metastases from CRC are best managed with a muhidisciplinary team （MDT） approach. MDTs contribute many advantages and benefits in cancer care for the patient.