结直肠癌肝转移的治疗进展

Recent advances in the treatment of colorectal liver metastases

肝转移是结直肠癌患者最主要的死亡原因,多学科团队诊断与治疗模式已成为结直肠癌肝转移规范化诊断与治疗的首要模式.通过对肝转移患者精准分期和分子分型,实现个体化的治疗.术前肝动脉联合肿瘤区域动脉灌注化疗,以及术中门静脉灌注化疗可减少Ⅲ期结直肠癌患者术后肝转移的发生.结直肠癌肝转移行手术切除已为所有学者所接受,并可辅以微创外科治疗.手术切除的适应证已扩展至肝内外肿瘤全部切除、切缘阴性、肝脏储备功能足够即可.原发灶和肝转移灶同期切除手术安全可行,但是否行新辅助化疗仍有争议.对于不可切除的肝转移,可实施转化治疗使肝转移灶转为可切除,对于无法转化不可切除的结直肠癌肝转移,需要积极综合治疗以控制疾病的进展.

Liver metastasis is the leading cause of death from colorectal cancer （CRC）.Multidisciplinary team model has become standard strategy for the diagnosis and treatment of colorectal liver metastases （CRLM）,making individualized treatment through precise staging and molecular typing.Preoperative hepatic and regional arterial infusion chemotherapy and portal vein chemotherapy during surgery can reduce the incidence of liver metastases for stage Ⅲ CRC.Surgical resection of CRLM has been accepted by all scholars,and can be performed by minimally invasive surgery.The criteria for hepatic resection of CRLM have been extended including complete tumor resection,negative resection margin and adequate remnant liver volume.Simultaneous resections of primary tumor and liver metastases are safe and feasible.However,neoadjuvant chemotherapy is still controversial.For unresectable liver metastases,conversion therapy should be implemented to make the liver metastases become resectable.For unconvertible and unresectable CRLM,aggressive and comprehensive treatment is required to control the disease progression.