切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2016, Vol. 05 ›› Issue (05) : 390 -397. doi: 10.3877/cma.j.issn.2095-3224.2016.05.005

所属专题: 文献

青年专家论坛

结直肠癌肝转移的可切除性判断
周鹏扬1, 王建伟1,()   
  1. 1. 310009 杭州,浙江大学医学院附属第二医院肿瘤外科
  • 收稿日期:2016-06-25 出版日期:2016-10-25
  • 通信作者: 王建伟
  • 基金资助:
    国家自然科学基金面上资助项目(No.81272677)

Assessment of resectability of colorectal liver metastasis

Pengyang Zhou1, Jianwei Wang1,()   

  1. 1. Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
  • Received:2016-06-25 Published:2016-10-25
  • Corresponding author: Jianwei Wang
  • About author:
    Corresponding author: Wang Jianwei, Email:
引用本文:

周鹏扬, 王建伟. 结直肠癌肝转移的可切除性判断[J/OL]. 中华结直肠疾病电子杂志, 2016, 05(05): 390-397.

Pengyang Zhou, Jianwei Wang. Assessment of resectability of colorectal liver metastasis[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2016, 05(05): 390-397.

结直肠癌最好发的转移部位是肝脏,手术是治愈结直肠癌肝转移并获得长期生存的唯一可能方式。就目前多学科治疗背景下,高效能的化疗方案联合靶向药物以及多种手术方式,如传统二步肝切除联合门静脉栓塞术/门静脉结扎术(portal vein embolization,PVE/portal vein ligation,PVL)及联合肝脏劈离及门静脉结扎的二期肝切除(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)的出现,包括各种消融等局部治疗手段拓展了过去对于肝脏可切除性的定义,而依据新的可切除标准对于可切除性的判断仍存在较大差异,本文将就肝脏可切除性判断展开探讨。

Liver is the most common site of metastasis in colorectal cancer. Hepatectomy as the treatment choice for patients seem to offer long-term survival and be the only chance for cure.The advent of aggressive interventions such as two-stage hepatectomy with portal vein embolization/ligation (PVE/PVL) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), high-effective chemotherapy regimen associated with targeted medicine and various ablation treatments has expanded the definition of hepatic resectability. But according to the recent resectability standard, there are still considerable differences in surgical decision making. To further illustrate this issue, we therefore investigate the resectability of colorectal liver metastasis.

表1 可切除定义的演变
[1]
DeSantis CE,Lin CC,Mariotto AB, et al. Cancer treatment and survivorship statistics, 2014[J]. CA Cancer J Clin, 2014, 64(4): 252-271.
[2]
Mayo SC,Heckman JE,Shore AD, et al. Shifting trends in liver-directed management of patients with colorectal liver metastasis: a population-based analysis[J]. Surgery, 2011, 150(2): 204-216.
[3]
Andres A,Toso C,Adam R, et al. A survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases: a LiverMetSurvey-based study[J]. Ann Surg, 2012, 256(5): 772-778; discussion 778-779.
[4]
Ekberg H,Tranberg KG,Andersson R,et al. Determinants of survival in liver resection for colorectal secondaries[J]. Br. J. Surg, 1986, 73(9): 727-731.
[5]
Folprecht G,Gruenberger T,Bechstein WO, et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial[J]. The lancet oncology, 2010, 11(1): 38-47.
[6]
Rees M,Tekkis PP,Welsh FK, et al. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients[J]. Ann Surg, 2008, 247(1): 125-135.
[7]
Adam R. Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases[J]. Annals of Oncology, 2003, 14(suppl 2): ii13-ii16.
[8]
Folprecht G,Gruenberger T,Bechstein W, et al. Survival of patients with initially unresectable colorectal liver metastases treated with FOLFOX/cetuximab or FOLFIRI/cetuximab in a multidisciplinary concept (CELIM study)[J]. Annals of Oncology, 2014, 25(5): 1018-1025.
[9]
Fong Y,Fortner J,Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases[J]. Annals of surgery, 1999, 230(2): 309-318.
[10]
Altendorf-Hofmann A,Scheele J. A critical review of the major indicators of prognosis after resection of hepatic metastases from colorectal carcinoma[J]. Surg Oncol Clin N Am, 2003, 12(1): 165-192.
[11]
Nagashima I,Takada T,Adachi M, et al. Proposal of criteria to select candidates with colorectal liver metastases for hepatic resection: comparison of our scoring system to the positive number of risk factors[J]. World Journal of Gastroenterology, 2006, 12(39): 6305-6309.
[12]
Yamaguchi T,Mori T,Takahashi K, et al. A new classification system for liver metastases from colorectal cancer in Japanese multicenter analysis[J]. Hepato-gastroenterology, 2008, 55(81): 173-178.
[13]
Malik HZ,Prasad KR,Halazun KJ, et al. Preoperative prognostic score for predicting survival after hepatic resection for colorectal liver metastases[J]. Ann Surg, 2007, 246(5): 806-814.
[14]
Minagawa M,Yamamoto J,Kosuge T, et al. Simplified staging system for predicting the prognosis of patients with resectable liver metastasis: development and validation. Archives of Surgery[J]. 2007, 142(3): 269-276.
[15]
Zakaria S,Donohue JH,Que FG, et al. Hepatic resection for colorectal metastases: value for risk scoring systems[J]? Ann Surg, 2007, 246(2): 183-191.
[16]
Tan MCB,Castaldo ET,Gao F, et al. A Prognostic System Applicable to Patients with Resectable Liver Metastasis from Colorectal Carcinoma Staged by Positron Emission Tomography with[18F]Fluoro-2-Deoxy-D-Glucose: Role of Primary Tumor Variables[J].Journal of the American College of Surgeons, 2008, 206(5): 857-868.
[17]
Konopke R,Kersting S,Distler M, et al. Prognostic factors and evaluation of a clinical score for predicting survival after resection of colorectal liver metastases[J]. Liver Int, 2009, 29(1): 89-102.
[18]
Nordlinger B,Guiguet M,Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients[J]. Cancer, 1996, 77(7): 1254-1262.
[19]
Cady B,Jenkins RL,Steele Jr GD, et al. Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome[J]. Annals of surgery, 1998, 227(4): 566-571.
[20]
Choti MA,Sitzmann JV,Tiburi MF, et al. Trends in Long-Term Survival Following Liver Resection for Hepatic Colorectal Metastases[J]. Annals of Surgery, 2002, 235(6): 759-766.
[21]
Pawlik TM,Scoggins CR,Zorzi D, et al. Effect of Surgical Margin Status on Survival and Site of Recurrence After Hepatic Resection for Colorectal Metastases[J]. Annals of Surgery, 2005, 241(5): 715-724.
[22]
Postriganova N,Kazaryan AM,Røsok BI, et al. Margin status after laparoscopic resection of colorectal liver metastases: does a narrow resection margin have an influence on survival and local recurrence[J]? HPB: The Official Journal of the International HepatoPancreato Biliary Association, 2014, 16(9): 822-829.
[23]
Andreou A,Aloia TA,Brouquet A, et al. Margin status remains an important determinant of survival after surgical resection of colorectal liver metastases in the era of modern chemotherapy[J]. Ann Surg, 2013, 257(6): 1079-1088.
[24]
de Haas RJ,Wicherts DA,Flores E, et al. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery[J]? Ann Surg, 2008, 248(4): 626-637.
[25]
Kato T,Yasui K,Hirai T, et al. Therapeutic results for hepatic metastasis of colorectal cancer with special reference to effectiveness of hepatectomy: analysis of prognostic factors for 763 cases recorded at 18 institutions[J]. Diseases of the colon and rectum, 2003, 46(10 Suppl): S22-S31.
[26]
Elias D,Liberale G,Vernerey D, et al. Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect[J]. Annals of surgical oncology, 2005, 12(11): 900-909.
[27]
Lehnert T,Knaebel HP,Dück M, et al. Sequential hepatic and pulmonary resections for metastatic colorectal cancer[J]. British Journal of Surgery, 1999, 86(2): 241-243.
[28]
Headrick JR,Miller DL,Nagorney DM, et al. Surgical treatment of hepatic and pulmonary metastases from colon cancer[J]. The Annals of Thoracic Surgery, 2001, 71(3): 975-980.
[29]
Miller G,Biernacki P,Kemeny NE, et al. Outcomes after Resection of Synchronous or Metachronous Hepatic and Pulmonary Colorectal Metastases[J]. Journal of the American College of Surgeons, 2007, 205(2): 231-238.
[30]
Adam R,de Haas RJ,Wicherts DA, et al. Concomitant extrahepatic disease in patients with colorectal liver metastases: when is there a place for surgery[J]? Annals of surgery, 2011, 253(2): 349-359.
[31]
Masi G,Cupini S,Marcucci L, et al. Treatment with 5-Fluorouracil/Folinic Acid, Oxaliplatin, and Irinotecan Enables Surgical Resection of Metastases in Patients With Initially Unresectable Metastatic Colorectal Cancer[J]. Annals of Surgical Oncology, 2006, 13(1): 58-65.
[32]
Van Cutsem E,Cervantes A,Nordlinger B, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Annals of oncology, 2014, 25(Suppl 3): iii1-iii9.
[33]
Venook AP,Blanke CD,Niedzwiecki D, et al. Revisiting the Cancer and Leukemia Group B/Southwest Oncology Group 80405 Trial: a phase III trial of chemotherapy and biologic agents for patients with untreated advanced colorectal adenocarcinoma[J]. Clinical colorectal cancer, 2007, 6(7): 536-538.
[34]
Ferrero A,Viganò L,Polastri R, et al. Postoperative Liver Dysfunction and Future Remnant Liver: Where Is the Limit[J]? World Journal of Surgery, 2007, 31(8): 1643-1651.
[35]
Zorzi D,Laurent A,Pawlik TM, et al. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases[J]. Br J Surg, 2007, 94(3): 274-286.
[36]
Abdalla EK,Denys A,Chevalier P, et al. Total and segmental liver volume variations: Implications for liver surgery[J]. Surgery, 2004, 135(4): 404-410.
[37]
Vicente E,Quijano Y,Ielpo B, et al. Is ʺsmall for size syndromeʺ a relatively new complication after the ALPPS procedure[J]? Updates in Surgery, 2015, 67(3): 273-278.
[38]
Adam R,Laurent A,Azoulay D, et al. Two-Stage Hepatectomy: A Planned Strategy to Treat Irresectable Liver Tumors[J]. Annals of Surgery, 2000, 232(6): 777-785.
[39]
Jaeck D,Oussoultzoglou E,Rosso E, et al. A Two-Stage Hepatectomy Procedure Combined With Portal Vein Embolization to Achieve Curative Resection for Initially Unresectable Multiple and Bilobar Colorectal Liver Metastases[J]. Annals of Surgery, 2004, 240(6): 1037-1051.
[40]
Farges O,Belghiti J,Kianmanesh R, et al. Portal Vein Embolization Before Right Hepatectomy: Prospective Clinical Trial[J]. Annals of Surgery, 2003, 237(2): 208-217.
[41]
Pamecha V,Nedjat-Shokouhi B,Gurusamy K, et al. Prospective evaluation of two-stage hepatectomy combined with selective portal vein embolisation and systemic chemotherapy for patients with unresectable bilobar colorectal liver metastases[J]. Digestive surgery, 2008, 25(5): 387-393.
[42]
Wicherts DA,Miller R,de Haas RJ, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases[J]. Ann Surg, 2008, 248(6): 994-1005.
[43]
Karoui M,Vigano L,Goyer P, et al. Combined first-stage hepatectomy and colorectal resection in a two-stage hepatectomy strategy for bilobar synchronous liver metastases[J]. The British journal of surgery, 2010, 97(9): 1354-1362.
[44]
Adam R,Laurent A,Azoulay D,et al. Two-Stage Hepatectomy: A Planned Strategy to Treat Irresectable Liver Tumors[J]. ANNALS OF SURGERY, 2000, 232(6): 777-785.
[45]
Benoist S,Brouquet A,Penna C, et al. Complete response of colorectal liver metastases after chemotherapy: does it mean cure[J]? J ClinOncol, 2006, 24(24): 3939-3945.
[46]
Brouquet A,Abdalla EK,Kopetz S, et al. High Survival Rate After Two-Stage Resection of Advanced Colorectal Liver Metastases: Response-Based Selection and Complete Resection Define Outcome[J]. Journal of Clinical Oncology, 2011, 29(8): 1083-1090.
[47]
Alvarez FA,Ardiles V,Sanchez Claria R, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks[J]. J Gastrointest Surg, 2013, 17(4): 814-821.
[48]
Schadde E,Ardiles V,Robles-Campos R, et al. Early survival and safety of ALPPS: first report of the International ALPPS Registry[J]. Ann Surg, 2014, 260(5): 829-838.
[49]
Schadde E,Ardiles V,Slankamenac K, et al. ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis[J]. World J Surg, 2014, 38(6): 1510-1519.
[50]
Rhim H,Dodd GD. Radiofrequency thermal ablation of liver tumors[J]. Journal of clinical ultrasound: JCU, 1999, 27(5): 221-229.
[51]
Veltri A,Guarnieri T,Gazzera C, et al. Long-term outcome of radiofrequency thermal ablation (RFA) of liver metastases from colorectal cancer (CRC): size as the leading prognostic factor for survival[J]. La radiologiamedica, 2012, 117(7): 1139-1151.
[52]
Gillams A,Lees W. Radiofrequency ablation of colorectal liver metastases[J]. Abdominal imaging, 2005, 30(4): 419-426.
[53]
Sørensen SM,Mortensen FV,Nielsen DT. Radiofrequency ablation of colorectal liver metastases: long-term survival[J]. ActaRadiologica, 2007, 48(3): 253-258.
[54]
Adam R,Delvart Vr,Pascal Gr, et al. Rescue Surgery for Unresectable Colorectal Liver Metastases Downstaged by Chemotherapy[J]. Ann Surg, 2004, 240(4): 644-657.
[55]
Capussotti L,Muratore A,Mulas MM, et al. Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases[J]. Br J Surg, 2006, 93(8): 1001-1006.
[56]
Kanas GP,Taylor A,Primrose JN, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors[J]. Clin Epidemiol, 2012, 4(1): 283-301.
[57]
Rubbia-Brandt L,Audard V,Sartoretti P, et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer[J]. Annals of Oncology, 2004, 15(3): 460-466.
[58]
Fernandez FG,Ritter J,Goodwin JW, et al. Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases[J]. Journal of the American College of Surgeons, 2005, 200(6): 845-853.
[59]
Pawlik TM,Olino K,Gleisner AL, et al. Preoperative chemotherapy for colorectal liver metastases: impact on hepatic histology and postoperative outcome[J]. Journal of Gastrointestinal Surgery, 2007, 11(7): 860-868.
[60]
Zhu D,Zhong Y,Wei Y, et al. Effect of Neoadjuvant Chemotherapy in Patients with Resectable Colorectal Liver Metastases[J]. PLoS ONE, 2014, 9(1): e86543.
[61]
de Haas RJ,Wicherts DA,Andreani P, et al. Impact of expanding criteria for resectability of colorectal metastases on short-and long-term outcomes after hepatic resection[J]. Ann Surg, 2011, 253(6): 1069-1079.
[1] 罗青杉, 梅海涛, 郝家领, 蔡锦锋, 周润楷, 温玉刚. 连接蛋白43通过调控细胞周期抑制结直肠癌的增殖机制研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 344-349.
[2] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[3] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[4] 施烨鑫, 马翔, 鲁明, 夏青城, 王鹏超, 宋青雨, 赵庆洪. 腹腔镜下结直肠肿瘤定位研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 463-466.
[5] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[6] 何慧玲, 鲁祖斌, 冯嘉莉, 梁声强. 术前外周血NLR和PLR对结肠癌术后肝转移的影响[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 682-687.
[7] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[8] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[9] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[10] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[11] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[12] 任佳琪, 刁德昌, 何自衍, 张雪阳, 唐新, 李文娟, 李洪明, 卢新泉, 易小江. 网膜融合线导向的脾曲游离技术在左半结肠癌根治术中的应用[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 362-367.
[13] 张迪, 王春霞, 张学东, 李发馨, 庞淅文, 陈一锋, 张维胜, 王涛. 梗阻性左半结直肠癌自膨式金属支架置入后行腹腔镜手术与开腹手术的短期临床疗效比较[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 375-380.
[14] 张蔚林, 王哲学, 白峻阁, 黄忠诚, 肖志刚. 利用TCGA数据库构建基于miRNA的结直肠癌列线图预后模型[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 381-388.
[15] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?