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🌱 來自: Metastatic Colon Cancer

Hepatic resection for colorectal cancer liver metastasis

• Approximately 153,000 patients are newly diagnosed with colorectal cancer (CRC) in the United States annually [1]. Among those who develop liver metastases, approximately 20 percent will be candidates for potentially curative liver resection.
• 在美國，每年約有 153，000 例新診斷為結直腸癌 (CRC) 的 → 患者[1]
• 在發生肝轉移的 → 患者中，大約 20%的 → 人可能適合進行治癒性肝切除術。
• Long-term survival after surgery for colorectal liver metastases (CRLMs) has improved dramatically, with five-year overall survival (OS) rates doubling from approximately 30 percent in the 1980s to 1990s to almost 60 percent in the last two decades.
• 結直腸肝轉移瘤 (CRLM) 手術後的 → 長期生存率顯著改善，五年總生存率 (OS) 從 1980 年代至 1990 年代的 → 約 30%翻了一番，在過去二十年中接近 60%。

We agree with guidelines developed from a consensus conference held by the American Hepato-Pancreato-Biliary Association, the Society for Surgery of the Alimentary Tract, and the Society of Surgical Oncology in 2006, which state [11]

我們同意美國肝胰膽協會、消化道外科學會和腫瘤外科學會於 2006 年召開的 → 共識會議制定的 → 指南，其中指出[11]：

• In patients undergoing liver resection for hepatic colorectal metastases, a positive surgical margin is → associated with a higher local recurrence and worse OS and should be avoided whenever possible. 在因肝結直腸轉移而接受肝切除術的 → 患者中，手術切緣陽性與較高的 → 局部復發率和更差的 → OS 相關，應盡可能 ☢ 避免。

• While a wide (>1 cm) resection margin should remain the goal when performing a liver resection, an anticipated margin of <1 cm should not be used as an exclusion criterion for resection. (See ‘Wide versus narrow margin’ below.) 雖然在進行肝切除術時，寬切緣 (>1 cm) 應仍然是目標，但 ✖ 不應將預期的 → 切緣<1 cm 作為切除的 → 排除標準。 (參見下文’寬邊距與窄邊距’)

• Assessment of resectability of hepatic colorectal metastases should focus on the ability to obtain a complete resection (negative margins). 肝結直腸轉移瘤可切除性的 → 評估應側重於獲得完全切除術 (陰性切緣) 的 → 能力。

• The feasibility of hepatic resection should also be based on three criteria related to the remaining liver following resection: (1) the ability to preserve two contiguous hepatic segments, (2) preservation of adequate vascular inflow and outflow as well as biliary drainage, and (3) the ability to preserve adequate future liver remnant (>20 percent in a healthy liver; >30 percent after chemotherapy). (See “Overview of hepatic resection”, section on ‘Contraindications’.) 肝切除術的 → 可行性還應基於與切除後剩餘肝臟相關的 → 三個標準： (1) 保留兩個相鄰肝段的 → 能力， (2) 保留足夠的 → 血管流入和流出以及膽道引流，以及 (3) 保留足夠的 → 未來肝臟殘留物的 → 能力 (健康肝臟中>20%;化療後>30%) 。 (參見 “肝切除概述”，關於’禁忌證’一節)

• The presence of extrahepatic disease should no longer be considered an absolute contraindication to hepatic resection provided the patient is → carefully selected and a complete (margin-negative) resection of both intra- and extrahepatic disease is → feasible. 肝外疾病的 → 存在 ✖ 不應再被視為肝切除術的 → 絕對禁忌證，前提是患者經過精心選擇，並且完全 (切緣陰性) 切除肝內和肝外疾病是可行的 → 。

Specific to the last point, portohepatic lymph node metastases associated with CRLMs are no longer considered an absolute contraindication to surgery [12-16]. Outcomes are more favorable when nodal involvement is → limited to the porta hepatis nodes, as opposed to the common hepatic artery or paraaortic nodes [13]. 具體到最後一點，與 CRLM 相關的 → 門靜脈淋巴結轉移 ✖ 不再被認為是手術的 → 絕對禁忌證[12-16]

• 與肝總動脈或主動脈旁結相比，淋巴結受累僅限於肝炎門淋巴結時，結局更有利[13]。

NEOADJUVANT CHEMOTHERAPY

RECIST (Response Evaluation Criteria in Solid Tumors