关键词: 结直肠癌肝转移, 同时性肝转移, 新辅助治疗疗, 同期切除, 分期切除, 腹腔镜

Abstract:

Choice of timing and approach for surgical treatment of synchronous colorectal liver metastases        CHEN Jin-hong,WANG Xiang-yu. Department of General Surgery,Huashan Hospital，Fudan University, Cancer Metastasis Institute，Fudan University，Shanghai 200040，China
Corresponding author: CHEN Jin-hong, E-mail: jinhongch@
hotmail.com
Abstract    Approximately 15% to 25% of colorectal cancer patients may present with synchronous liver metastasis (sCRLM) at or before diagnosis of the primary tumor. In recent years, the development of treatment concept and surgical techniques has lead to revolutionary changes in clinical management of sCRLM, which also brings some confusion and debates. Compared to direct operation, the addition of neoadjuvant chemotherapy may have potential clinical efficacy in specific sCRLM patients, especially in those who harbor high-risk recurrence factors. Combined resection of the primary tumor and liver metastases arises in recent years, and its safety and effectiveness have been validated. Meanwhile, “liver first approach” for staged resection has also been proposed and implemented in some centers. Lastly, minimally invasive (laparoscopic and robot-assisted) surgery could further improve the clinical efficacy of combined resection of sCRLM than traditional open approach. However, The lack of validated evidence is the biggest difficulty in clinical treatment of sCRLM. The status of neoadjuvant therapy, sequence choice of staged resection, patients screening of combined resection and the application of minimally invasive technology need further exploration and research.

Key words: colorectal liver metastasis, synchronous liver metastasis, neoadjuvant therapy, combined resection, staged resection, laparoscope