结直肠癌肝脏寡转移治疗策略

Treatment strategies for colorectal liver oligometastases

结直肠癌肝脏寡转移(CRLOM)是指原发的结直肠癌可控(已经或可以被切除),肝转移灶数量有限且能够进行安全有效的局部治疗。CRLOM发病率高、预后差,目前主要采用以手术为基础的综合治疗策略,包括转化治疗、新辅助治疗、肝转移瘤切除术、术后辅助治疗等,其中转化治疗分为剩余肝脏体积(FLR)转化和肿瘤学转化,FLR转化包括门静脉栓塞术、门静脉结扎术、联合肝脏分隔和门静脉结扎二步肝切除术以及肝静脉剥夺术。消融治疗、经动脉介入治疗、放射治疗等局部治疗措施可以用于提高CRLOM的手术治疗效果或治疗不可切除CRLOM。肝移植术对于经严格筛选的不可切除CRLOM病人治疗效果良好。须考虑CRLOM病人的实际情况,制定个体化治疗策略。

Colorectal liver oligometastasis(CRLOM)refers to the controlled(already resected or resectable)primary colorectal cancer with a limited number of liver metastases that can be safely and effectively treated locally.The incidence rate of CRLOM is high but its prognosis is poor.At present,comprehensive treatment strategies based on surgery are mainly used,including conversion therapy,neoadjuvant therapy,resection of liver metastases,postoperative adjuvant therapy,etc.Among them,conversion therapy is divided into residual liver volume(FLR)conversion and oncological conversion,and FLR conversion includes portal vein embolization(PVE),portal vein ligation(PVL),associated liver partition and portal vein ligation for staged hepatectomy(ALPPS)and liver vein deprivation(LVD).Local treatment measures such as ablation,transcatheter intra-arterial therapy,and radiation therapy can be applied to improve the surgical efficacy of CRLOM or unresectable CRLOM.Liver transplantation has a good therapeutic effect on patients with unresectable CRLOM who have undergone strict screening.To develop personalized treatment strategies,the actual situation of CRLOM patients should be taken into consideration.