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中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (04) : 356 -360. doi: 10.3877/cma.j.issn.2095-3232.2022.04.007

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结直肠癌肝转移外科治疗进展
陈振潮1, 陆录1,()   
  1. 1. 200040 上海,复旦大学附属华山医院普通外科 复旦大学肿瘤转移研究所
  • 收稿日期:2022-04-27 出版日期:2022-08-10
  • 通信作者: 陆录
  • 基金资助:
    国家科技重大专项(2017ZX10203207)

Recent advance in surgical treatments for colorectal liver metastasis

Zhenchao Chen1, Lu Lu1()   

  • Received:2022-04-27 Published:2022-08-10
  • Corresponding author: Lu Lu
引用本文:

陈振潮, 陆录. 结直肠癌肝转移外科治疗进展[J]. 中华肝脏外科手术学电子杂志, 2022, 11(04): 356-360.

Zhenchao Chen, Lu Lu. Recent advance in surgical treatments for colorectal liver metastasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(04): 356-360.

结直肠癌是常见的恶性肿瘤之一,目前发病率居全球第3位,在我国居第2位,致死率居全球第2位[1]。肝脏是结直肠癌远处转移最常见的靶器官,根据流行病学统计,15%~25%的患者在初次诊断时即发现同步肝转移,另有15%~25%的患者在根治性切除原发肿瘤后发生异时性肝转移,这些患者中70%~90%的肝转移灶初始无法获得根治性切除,未经治疗的肝转移患者中位生存期为6.9个月,5年生存率低于5%[2,3]。目前认为在MDT下,联合各种综合治疗方式,配合手术和局部治疗,将大大提高肝转移患者手术切除率和总体生存率。本文对近年结直肠癌肝转移(colorectal liver metastasis,CRLM)的外科治疗进展进行阐述。

[1]
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249.
[2]
Ren L, Zhu D, Benson AB 3rd, et al. Shanghai international consensus on diagnosis and comprehensive treatment of colorectal liver metastases (version 2019)[J]. Eur J Surg Oncol, 2020, 46(6): 955-966.
[3]
中国医师协会外科医师分会,中华医学会外科分会胃肠外科学组,中华医学会外科分会结直肠外科学组,等. 中国结直肠癌肝转移诊断和综合治疗指南(2020版)[J]. 临床肝胆病杂志, 2021, 37(3):543-553.
[4]
Hamady ZZ, Lodge JP, Welsh FK, et al. One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach[J]. Ann Surg, 2014, 259(3):543-548.
[5]
Margonis GA, Sergentanis TN, Ntanasis-Stathopoulos I, et al. Impact of surgical margin width on recurrence and overall survival following R0 hepatic resection of colorectal metastases: a systematic review and meta-analysis[J]. Ann Surg, 2018, 267(6):1047-1055.
[6]
Ardito F, Panettieri E, Vellone M, et al. The impact of R1 resection for colorectal liver metastases on local recurrence and overall survival in the era of modern chemotherapy: an analysis of 1,428 resection areas[J]. Surgery, 2019, 165(4):712-720.
[7]
Xu D, Wang HW, Yan XL, et al. Sub-millimeter surgical margin is acceptable in patients with good tumor biology after liver resection for colorectal liver metastases[J]. Eur J Surg Oncol, 2019, 45(9): 1551-1558.
[8]
Oshi M, Margonis GA, Sawada Y, et al. Higher tumor burden neutralizes negative margin status in hepatectomy for colorectal cancer liver metastasis[J]. Ann Surg Oncol, 2019, 26(2):593-603.
[9]
Adam R. Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases[J]. Ann Oncol, 2003, 14 Suppl 2:ii13-16.
[10]
Tournigand C, André T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer:a randomized GERCOR study[J]. J Clin Oncol, 2004, 22(2):229-237.
[11]
Falcone A, Ricci S, Brunetti I, et al. Phase Ⅲ trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest[J]. J Clin Oncol, 2007, 25(13): 1670-1676.
[12]
Masi G, Vasile E, Loupakis F, et al. Randomized trial of two induction chemotherapy regimens in metastatic colorectal cancer: an updated analysis[J]. J Natl Cancer Inst, 2011, 103(1):21-30.
[13]
Hu H, Wang K, Huang M, et al. Modified FOLFOXIRI with or without cetuximab as conversion therapy in patients with RAS/BRAF wild-type unresectable liver metastases colorectal cancer: the FOCULM multicenter phase Ⅱ trial[J]. Oncologist, 2021, 26(1):e90-98.
[14]
Tomasello G, Petrelli F, Ghidini M, et al. FOLFOXIRI plus bevacizumab as conversion therapy for patients with initially unresectable metastatic colorectal cancer: a systematic review and pooled analysis[J]. JAMA Oncol, 2017, 3(7):e170278.
[15]
Basso M, Dadduzio V, Ardito F, et al. Conversion chemotherapy for technically unresectable colorectal liver metastases: a retrospective, STROBE-compliant, single-center study comparing chemotherapy alone and combination chemotherapy with cetuximab or bevacizumab[J]. Medicine, 2016, 95(20):e3722.
[16]
Chen D, Zhang X, Gao G, et al. Should anti-EGFR mAbs be discontinued for conversion surgery in untreated right-sided metastatic colorectal cancer? a systematic review and meta-analysis[J]. World J Surg Oncol, 2018, 16(1):200.
[17]
Benson AB, Venook AP, Al-Hawary MM, et al. NCCN guidelines insights: rectal cancer, version 6.2020[J]. J Natl Compr Canc Netw, 2020, 18(7):806-815.
[18]
Schadde E, Grunhagen DJ, Verhoef C, et al. Limitations in resectability of colorectal liver metastases 2020-a systematic approach for clinicians and patients[J]. Semin Cancer Biol, 2021(71): 10-20.
[19]
Deng G, Li H, Jia GQ, et al. Parenchymal-sparing versus extended hepatectomy for colorectal liver metastases: a systematic review and meta-analysis[J]. Cancer Med, 2019, 8(14):6165-6175.
[20]
Imai K, Allard MA, Castro Benitez C, et al. Long-term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases[J]. Br J Surg, 2017, 104(5):570-579.
[21]
Huang Y, Ge W, Kong Y, et al. Preoperative portal vein embolization for liver resection: an updated meta-analysis[J]. J Cancer, 2021, 12(6):1770-1778.
[22]
Collin Y, Paré A, Belblidia A, et al. Portal vein embolization does not affect the long-term survival and risk of cancer recurrence among colorectal liver metastases patients: a prospective cohort study[J]. Int J Surg, 2019(61):42-47.
[23]
Fischer C, Melstrom LG, Arnaoutakis D, et al. Chemotherapy after portal vein embolization to protect against tumor growth during liver hypertrophy before hepatectomy[J]. JAMA Surg, 2013, 148(12): 1103-1108.
[24]
Khayat S, Cassese G, Quenet F, et al. Oncological outcomes after liver venous deprivation for colorectal liver metastases: a single center experience[J]. Cancers, 2021, 13(2):200.
[25]
Sandström P, Røsok BI, Sparrelid E, et al. ALPPS improves resectability compared with conventional two-stage hepatectomy in patients with advanced colorectal liver metastasis: results froma scandinavian multicenter randomized controlled trial (LIGRO trial)[J]. Ann Surg, 2018, 267(5):833-840.
[26]
Zhang L, Yang Z, Zhang S, et al. Conventional two-stage hepatectomy or associating liver partitioning and portal vein ligation for staged hepatectomy for colorectal liver metastases? a systematic review and meta-analysis[J]. Front Oncol, 2020(10):1391.
[27]
Petrowsky H, Linecker M, Raptis DA, et al. First long-term oncologic results of the ALPPS procedure in a large cohort of patients with colorectal liver metastases[J]. Ann Surg, 2020, 272(5): 793-800.
[28]
Aghayan DL, Kazaryan AM, Dagenborg VJ, et al. Long-term oncologic outcomes after laparoscopic versus open resection for colorectal liver metastases: a randomized trial[J]. Ann Intern Med, 2021, 174(2):175-182.
[29]
Ratti F, Fiorentini G, Cipriani F, et al. Laparoscopic vs open surgery for colorectal liver metastases[J]. JAMA Surg, 2018, 153(11):1028-1035.
[30]
Martínez-Cecilia D, Cipriani F, Shelat V, et al. Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients: a multicenter propensity score based analysis of short- and long-term outcomes[J]. Ann Surg, 2017, 265(6):1192-1200.
[31]
Starzl TE. The saga of liver replacement, with particular reference to the reciprocal influence of liver and kidney transplantation (1955-1967)[J]. J Am Coll Surg, 2002, 195(5):587-610.
[32]
Hagness M, Foss A, Line PD, et al. Liver transplantation for nonresectable liver metastases from colorectal cancer[J]. Ann Surg, 2013, 257(5):800-806.
[33]
Rosen CB, Nagorney DM, Alberts SR. Is there a role for liver transplantation in the treatment of patients with metastatic colorectal cancer?[J]. Ann Surg, 2020, 271(2):219-220.
[34]
Dueland S, Syversveen T, Solheim JM, et al. Survival following liver transplantation for patients with nonresectable liver-only colorectal metastases[J]. Ann Surg, 2020, 271(2):212-218.
[35]
Dueland S, Grut H, Syversveen T, et al. Selection criteria related to long-term survival following liver transplantation for colorectal liver metastasis[J]. Am J Transplant, 2020, 20(2):530-537.
[36]
Line PD, Dueland S. Liver transplantation for secondary liver tumours: the difficult balance between survival and recurrence[J]. J Hepatol, 2020, 73(6):1557-1562.
[37]
姜中豪,朝六. 多学科综合治疗时代肝癌外科新理念[J/CD].中华普通外科学文献(电子版), 2020, 14(6):401-405.
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