结直肠癌肝转移外科治疗相关问题思考

Considerations of discussional topics about surgical managements for colorectal liver metastases

外科治疗在结直肠癌肝转移治疗中取到了越来越大的作用,但适应症和时机的选择有所争议。对于属于寡转移的结直肠癌肝转移病例应采取积极的手术切除、射频消融、立体定向放疗包括肝移植等局部治疗措施使患者获得根治性治疗,初治患者的序贯治疗顺序应当结合患者具体情况,在多学科团队诊治模式下确定治疗顺序。结直肠癌肝转移肝切除术中与原发性肝癌手术有所不同,推荐采用保留肝实质的肝切除技术。

The surgical managements play more important roles in the treatments for colorectal liver metastases, However, the operation indication and the proper time for surgical intervention are controversial. The oligometastatic state of colorectal liver metastasis patients might achieve long-term survival and better life qualities if all the metastatic lesions are resected or destructed, using techniques such as surgely, radiofrequency destruction or stereotactic radiotherapy and even liver transplant. The initial treatment sequencing for simultaneous colorectal liver metastases should be decided by MDT. The parenchyma-sparing liver resection is recommended in the liver resection for colorectal liver metastases, which is different from the liver resection for primaiy hepatocellular carcinoma.