结直肠癌肝转移的非根治性切除手术治疗策略

张瑞; 陈进宏

doi:10.12449/JCH240702

结直肠癌肝转移的非根治性切除手术治疗策略

DOI: 10.12449/JCH240702

张瑞,
陈进宏^, ,

复旦大学附属华山医院普外科肝胆外科中心，上海 200040

基金项目:

国家自然科学基金 (82272836);

上海市“科技创新行动计划”优秀学术带头人计划项目 (22XD1400300)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：张瑞负责文献资料收集和分析，撰写论文；陈进宏负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
陈进宏， jinhongch@hotmail.com （ORCID： 0000-0003-0952-9990）

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出版历程
- 收稿日期: 2024-04-01
- 录用日期: 2024-04-30
- 出版日期: 2024-07-25

Treatment strategy of non-radical surgical resection for colorectal cancer liver metastases

Rui ZHANG,
Jinhong CHEN^{,
,}

Center of Hepatobiliary Surgery，Department of General Surgery，Huashan Hospital，Fudan University，Shanghai 200040，China

Research funding:

National Natural Science Foundation of China (82272836);

Excellent Academic Leader Project of Shanghai “Science and Technology Innovation Action Plan” (22XD1400300)

More Information

Corresponding author: CHEN Jinhong， jinhongch@hotmail.com （ORCID： 0000-0003-0952-9990）

摘要

摘要: 有效治疗结直肠癌肝转移是提高结直肠癌患者生存率和生活质量的关键。随着系统性化疗的应用，结直肠癌肝转移患者的转化率和手术切除率越来越高。非根治性切除手术是肿瘤外科的手术策略之一。本文将主要针对结直肠癌肝转移初始不可切除患者，包括存在肝外转移、肝转移瘤R1切除以及肝转移瘤分步手术和减瘤手术等，阐述非根治性切除手术在结直肠癌肝转移治疗中的应用。
- 结直肠肿瘤 /
- 肿瘤转移 /
- 肝 /
- 治疗学
Abstract: Effective treatment of colorectal cancer liver metastases is crucial for improving the survival rate and quality of life of patients with colorectal cancer. With the application of systemic chemotherapy， there have been increases in the conversion rate and surgical resection rate of patients with colorectal cancer liver metastases. Non-radical resection is one of the surgical strategies in tumor surgery. This article reviews the treatment of patients with initially unresectable colorectal cancer liver metastases， including extrahepatic metastasis， R1 resection of liver metastases， staged surgery for liver metastases， and debulking surgery， as well as the application of non-radical resection in the treatment of colorectal cancer liver metastases.
- Colorectal Neoplasms /
- Neoplasm Metastasis /
- Liver /
- Therapeutics

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参考文献(45)

[1]	WANG HM, SHAN XF, ZHANG M, et al. Homogeneous and heterogeneous risk and prognostic factors for lung metastasis in colorectal cancer patients[J]. BMC Gastroenterol, 2022, 22( 1): 193. DOI: 10.1186/s12876-022-02270-5.
[2]	PEREIRA AAL, REGO JFM, MORRIS V, et al. Association between KRAS mutation and lung metastasis in advanced colorectal cancer[J]. Br J Cancer, 2015, 112( 3): 424- 428. DOI: 10.1038/bjc.2014.619.
[3]	CHO JH, HAMAJI M, ALLEN MS, et al. The prognosis of pulmonary metastasectomy depends on the location of the primary colorectal cancer[J]. Ann Thorac Surg, 2014, 98( 4): 1231- 1237. DOI: 10.1016/j.athoracsur.2014.05.023.
[4]	ELIAS D, SIDERIS L, POCARD M, et al. Results of R0 resection for colorectal liver metastases associated with extrahepatic disease[J]. Ann Surg Oncol, 2004, 11( 3): 274- 280. DOI: 10.1245/aso.2004.03.085.
[5]	STEWART CL, WARNER S, ITO K, et al. Cytoreduction for colorectal metastases: Liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure?[J]. Curr Probl Surg, 2018, 55( 9): 330- 379. DOI: 10.1067/j.cpsurg.2018.08.004.
[6]	VEGA EA, SALEHI O, NICOLAESCU D, et al. Failure to cure patients with colorectal liver metastases: The impact of the liver surgeon[J]. Ann Surg Oncol, 2021, 28( 12): 7698- 7706. DOI: 10.1245/s10434-021-10030-0.
[7]	MINAGAWA M, MAKUUCHI M, TORZILLI G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: Long-term results[J]. Ann Surg, 2000, 231( 4): 487- 499. DOI: 10.1097/00000658-200004000-00006.
[8]	HASSELGREN K, ISAKSSON B, ARDNOR B, et al. Liver resection is beneficial for patients with colorectal liver metastases and extrahepatic disease[J]. Ann Transl Med, 2020, 8( 4): 109. DOI: 10.21037/atm.2019.12.125.
[9]	MISE Y, KOPETZ S, MEHRAN RJ, et al. Is complete liver resection without resection of synchronous lung metastases justified?[J]. Ann Surg Oncol, 2015, 22( 5): 1585- 1592. DOI: 10.1245/s10434-014-4207-3.
[10]	ALBERTSMEIER M, RIEDL K, STEPHAN AJ, et al. Improved survival after resection of colorectal liver metastases in patients with unresectable lung metastases[J]. HPB(Oxford), 2020, 22( 3): 368- 375. DOI: 10.1016/j.hpb.2019.07.004.
[11]	MAITHEL SK, GINSBERG MS, D’AMICO F, et al. Natural history of patients with subcentimeter pulmonary nodules undergoing hepatic resection for metastatic colorectal cancer[J]. J Am Coll Surg, 2010, 210( 1): 31- 38. DOI: 10.1016/j.jamcollsurg.2009.09.032.
[12]	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. DOI: 10.1016/j.surg.2018.09.005.
[13]	PROCOPIO F, VIGANÒ L, CIMINO M, et al. Does KRAS mutation status impact the risk of local recurrence after R1 vascular resection for colorectal liver metastasis? An observational cohort study[J]. Eur J Surg Oncol, 2020, 46( 5): 818- 824. DOI: 10.1016/j.ejso.2019.12.004.
[14]	SAKAI N, FURUKAWA K, TAKAYASHIKI T, et al. Recurrence patterns and their effects on clinical outcomes after R1 resection of colorectal liver metastases: A propensity score-matched analysis[J]. Langenbecks Arch Surg, 2021, 406( 8): 2739- 2747. DOI: 10.1007/s00423-021-02096-x.
[15]	KIM NR, ALHOTHAIFI ED, HAN DH, et al. Prognostic impact of R1 resection margin in synchronous and simultaneous colorectal liver metastasis resection: A retrospective cohort study[J]. World J Surg Oncol, 2023, 21( 1): 169. DOI: 10.1186/s12957-023-03042-5.
[16]	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. DOI: 10.1097/SLA.0b013e31818a07f1.
[17]	TRUANT S, SÉQUIER C, LETEURTRE E, et al. Tumour biology of colorectal liver metastasis is a more important factor in survival than surgical margin clearance in the era of modern chemotherapy regimens[J]. HPB(Oxford), 2015, 17( 2): 176- 184. DOI: 10.1111/hpb.12316.
[18]	PENCOVICH N, HOULI R, LUBEZKY N, et al. R1 resection of colorectal liver metastasis- What is the cost of marginal resection?[J]. J Surg Oncol, 2019, 119( 3): 347- 354. DOI: 10.1002/jso.25321.
[19]	MCVEY JC, SASAKI K, MARGONIS GA, et al. The impact of resection margin on overall survival for patients with colon cancer liver metastasis varied according to the primary cancer location[J]. HPB(Oxford), 2019, 21( 6): 702- 710. DOI: 10.1016/j.hpb.2018.11.001.
[20]	AYEZ N, LALMAHOMED ZS, EGGERMONT AMM, et al. Outcome of microscopic incomplete resection(R1) of colorectal liver metastases in the era of neoadjuvant chemotherapy[J]. Ann Surg Oncol, 2012, 19( 5): 1618- 1627. DOI: 10.1245/s10434-011-2114-4.
[21]	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. DOI: 10.1097/SLA.0b013e318283a4d1.
[22]	SASAKI K, MARGONIS GA, MAITANI K, et al. The prognostic impact of determining resection margin status for multiple colorectal metastases according to the margin of the largest lesion[J]. Ann Surg Oncol, 2017, 24( 9): 2438- 2446. DOI: 10.1245/s10434-017-5904-5.
[23]	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. DOI: 10.1245/s10434-018-6830-x.
[24]	MARGONIS GA, SASAKI K, ANDREATOS N, et al. KRAS mutation status dictates optimal surgical margin width in patients undergoing resection of colorectal liver metastases[J]. Ann Surg Oncol, 2017, 24( 1): 264- 271. DOI: 10.1245/s10434-016-5609-1.
[25]	WANG HW, WANG LJ, JIN KM, et al. The prognostic impact of resection margin status varies according to the genetic and morphological evaluation(GAME) score for colorectal liver metastasis[J]. J Surg Oncol, 2021, 124( 4): 619- 626. DOI: 10.1002/jso.26557.
[26]	ANDREOU A, KNITTER S, SCHMELZLE M, et al. Recurrence at surgical margin following hepatectomy for colorectal liver metastases is not associated with R1 resection and does not impact survival[J]. Surgery, 2021, 169( 5): 1061- 1068. DOI: 10.1016/j.surg.2020.11.024.
[27]	VIGANÒ L, PROCOPIO F, CIMINO MM, et al. Is tumor detachment from vascular structures equivalent to R0 resection in surgery for colorectal liver metastases? An observational cohort[J]. Ann Surg Oncol, 2016, 23( 4): 1352- 1360. DOI: 10.1245/s10434-015-5009-y.
[28]	NISHIOKA Y, PAEZ-ARANGO N, BOETTCHER FO, et al. Neither surgical margin status nor somatic mutation predicts local recurrence after R0-intent resection for colorectal liver metastases[J]. J Gastrointest Surg, 2022, 26( 4): 791- 801. DOI: 10.1007/s11605-021-05173-0.
[29]	TRANCHART H, CHIRICA M, FARON M, et al. Prognostic impact of positive surgical margins after resection of colorectal cancer liver metastases: Reappraisal in the era of modern chemotherapy[J]. World J Surg, 2013, 37( 11): 2647- 2654. DOI: 10.1007/s00268-013-2186-3.
[30]	LAURENT C, ADAM JP, DENOST Q, et al. Significance of R1 resection for advanced colorectal liver metastases in the era of modern effective chemotherapy[J]. World J Surg, 2016, 40( 5): 1191- 1199. DOI: 10.1007/s00268-016-3404-6.
[31]	WEBER SM, JARNAGIN WR, DEMATTEO RP, et al. Survival after resection of multiple hepatic colorectal metastases[J]. Ann Surg Oncol, 2000, 7( 9): 643- 650. DOI: 10.1007/s10434-000-0643-3.
[32]	MOHAMMAD WM, MARTEL G, MIMEAULT R, et al. Evaluating agreement regarding the resectability of colorectal liver metastases: A national case-based survey of hepatic surgeons[J]. HPB(Oxford), 2012, 14( 5): 291- 297. DOI: 10.1111/j.1477-2574.2012.00440.x.
[33]	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. DOI: 10.1097/SLA.0b013e3181907fd9.
[34]	PICARDO A, KARPOFF HM, NG B, et al. Partial hepatectomy accelerates local tumor growth: Potential roles of local cytokine activation[J]. Surgery, 1998, 124( 1): 57- 64. DOI: 10.1016/s0039-6060(98)70075-3.
[35]	ADAM R, LAURENT A, AZOULAY D, et al. Two-stage hepatectomy: A planned strategy to treat irresectable liver tumors[J]. Ann Surg, 2000, 232( 6): 777- 785. DOI: 10.1097/00000658-200012000-00006.
[36]	BRISTOW RE, TOMACRUZ RS, ARMSTRONG DK, et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: A meta-analysis[J]. J Clin Oncol, 2023, 41( 25): 4065- 4076. DOI: 10.1200/JCO.22.02765.
[37]	ALLARD MA, ADAM R, GIULIANTE F, et al. Long-term outcomes of patients with 10 or more colorectal liver metastases[J]. Br J Cancer, 2017, 117( 5): 604- 611. DOI: 10.1038/bjc.2017.218.
[38]	TANAKA K, MURAKAMI T, YABUSHITA Y, et al. Maximal debulking liver resection as a beneficial treatment strategy for advanced and aggressive colorectal liver metastases[J]. Anticancer Res, 2014, 34( 10): 5547- 5554.
[39]	ADAM R, KITANO Y, ABDELRAFEE A, et al. Debulking surgery for colorectal liver metastases: Foolish or chance?[J]. Surg Oncol, 2020, 33: 266- 269. DOI: 10.1016/j.suronc.2020.02.008.
[40]	COHEN PA, POWELL A, BÖHM S, et al. Pathological chemotherapy response score is prognostic in tubo-ovarian high-grade serous carcinoma: A systematic review and meta-analysis of individual patient data[J]. Gynecol Oncol, 2019, 154( 2): 441- 448. DOI: 10.1016/j.ygyno.2019.04.679.
[41]	YANG D, KHAN S, SUN Y, et al. Association of BRCA1 and BRCA2 mutations with survival, chemotherapy sensitivity, and gene mutator phenotype in patients with ovarian cancer[J]. JAMA, 2011, 306( 14): 1557- 1565. DOI: 10.1001/jama.2011.1456.
[42]	BRAICU EI, CHEKEROV R, RICHTER R, et al. HE4 expression in plasma correlates with surgical outcome and overall survival in patients with first ovarian cancer relapse[J]. Ann Surg Oncol, 2014, 21( 3): 955- 962. DOI: 10.1245/s10434-013-3347-1.
[43]	LIU JF, KINDELBERGER D, DOYLE C, et al. Predictive value of circulating tumor cells(CTCs) in newly-diagnosed and recurrent ovarian cancer patients[J]. Gynecol Oncol, 2013, 131( 2): 352- 356. DOI: 10.1016/j.ygyno.2013.08.006.
[44]	LAUBY A, COLOMBAN O, CORBAUX P, et al. The increasing prognostic and predictive roles of the tumor primary chemosensitivity assessed by CA-125 elimination rate constant K(KELIM) in ovarian cancer: A narrative review[J]. Cancers(Basel), 2021, 14( 1): 98. DOI: 10.3390/cancers14010098.
[45]	YOU B, FREYER G, GONZALEZ-MARTIN A, et al. The role of the tumor primary chemosensitivity relative to the success of the medical-surgical management in patients with advanced ovarian carcinomas[J]. Cancer Treat Rev, 2021, 100: 102294. DOI: 10.1016/j.ctrv.2021.102294.