摘要
Recently, there has been a change in the strategy of how synchronous colorectal hepatic metastases are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatment of colorectal neoplasms and their hepatic metastases. There is a consensus that patients with synchronous colorectal hepatic metastases have lower survival than those with metachronous colorectal hepatic metastases. Currently, controversy remains concerning the best approach is sequence in a patient with colorectal cancer and synchronous hepatic metastases resection. To obtain a better patient selection, the authors have suggested the initial realization of systemic chemotherapy in the circumstance of patients with colorectal tumor stage Ⅳ, since these patients have a systemic disease. The rationale behind this liver-first strategy is initially the control of synchronous hepatic metastases of colorectal carcinoma, which can optimize a potentially curative hepatic resection and longstanding survival. The liver-first strategy procedure is indicated for patients with colorectal hepatic metastases who require downstaging therapy to make a curative liver resection possible. Thus, the liver-first strategy is considered an option in cases of rectal carcinoma in the early stage and with limited or advanced synchronous colorectal hepatic metastases or in case of patients with asymptomatic colorectal carcinoma, but with extensive liver metastases. Patients undergoing systemic chemotherapy and with progression of neoplastic disease should not undergo hepatic resection, because it does not change the prognosis and may even make it worse. To date, there have been no randomized controlled trials on surgical approach of colorectal synchronous hepatic metastases, despite the relatively high number of available manuscripts on this subject. All of these published studies are observational, usually retrospective, and often non-comparative. The patient selection criteria for the liver-first strategy should be individualized, and the approach of these patients should be performed by a multidisciplinary team so its benefits will be fully realized.
Recently, there has been a change in the strategy ofhow synchronous colorectal hepatic metastases areattributed to the development of more valuable protocolsof chemotherapy and radiotherapy for neoadjuvanttreatment of colorectal neoplasms and their hepaticmetastases. There is a consensus that patients withsynchronous colorectal hepatic metastases have lowersurvival than those with metachronous colorectal hepaticmetastases. Currently, controversy remains concerningthe best approach is sequence in a patient withcolorectal cancer and synchronous hepatic metastasesresection. To obtain a better patient selection, theauthors have suggested the initial realization of systemicchemotherapy in the circumstance of patients withcolorectal tumor stage Ⅳ, since these patients have asystemic disease. The rationale behind this liver-firststrategy is initially the control of synchronous hepaticmetastases of colorectal carcinoma, which can optimizea potentially curative hepatic resection and longstandingsurvival. The liver-first strategy procedure is indicatedfor patients with colorectal hepatic metastases whorequire downstaging therapy to make a curative liverresection possible. Thus, the liver-first strategy isconsidered an option in cases of rectal carcinoma in theearly stage and with limited or advanced synchronouscolorectal hepatic metastases or in case of patientswith asymptomatic colorectal carcinoma, but withextensive liver metastases. Patients undergoing systemicchemotherapy and with progression of neoplasticdisease should not undergo hepatic resection, becauseit does not change the prognosis and may even makeit worse. To date, there have been no randomizedcontrolled trials on surgical approach of colorectalsynchronous hepatic metastases, despite the relativelyhigh number of available manuscripts on this subject.All of these published studies are observational, usuallyretrospective, and often non-comparative. The patientselection criteria for the liver-first strategy should beindividualized, and the approach of these patients shouldbe performed by a multidisciplinary team so its benefitswill be fully realized.
