PDF(Pubmed)
Abstract：
The incidence of colorectal cancer and colorectal liver metastases (CRLM) is increasing globally due to an interaction of environmental and genetic factors. A minority of patients with CRLM have surgically resectable disease, but for those who have resection as part of multimodal therapy for their disease, long-term survival has been shown. Precision surgery-the idea of careful patient selection and targeting of surgical intervention, such that treatments shown to be proven to benefit on a population level are the optimal treatment for each individual patient-is the new paradigm of care. Key to this is the understanding of tumour molecular biology and clinically relevant mutations, such as KRAS, BRAF, and microsatellite instability (MSI), which can predict poorer overall outcomes and a poorer response to systemic therapy. The emergence of immunotherapy and hepatic artery infusion (HAI) pumps show potential to convert previously unresectable disease to resectable disease, in addition to established systemic and locoregional therapies, but the surgeon must be wary of poor-quality livers and the spectre of post-hepatectomy liver failure (PHLF). Volume modulation, a cornerstone of hepatic surgery for a generation, has been given a shot in the arm with the advent of liver venous depletion (LVD) ensuring significantly more hypertrophy of the future liver remnant (FLR). The optimal timing of liver resection for those patients with synchronous disease is yet to be truly established, but evidence would suggest that those patients requiring complex colorectal surgery and major liver resection are best served with a staged approach. In the operating room, parenchyma-preserving minimally invasive surgery (MIS) can dramatically reduce the surgical insult to the patient and lead to better perioperative outcomes, with quicker return to function.
摘要：
由于环境和遗传因素的相互作用，全球结直肠癌和结直肠癌肝转移（CRLM）的发病率正在增加。少数CRLM患者患有可手术切除的疾病，但是对于那些在多模式治疗中接受切除手术的人来说，已经证明了长期生存。精准手术-精心选择患者并针对手术干预的想法，因此，被证明在人群水平上受益的治疗是每个患者的最佳治疗方法-是新的护理范式。关键是了解肿瘤分子生物学和临床相关突变，比如KRAS,BRAF,和微卫星不稳定性(MSI)，这可以预测较差的总体结局和对全身治疗的较差反应。免疫疗法和肝动脉输注（HAI）泵的出现显示出将以前无法切除的疾病转化为可切除的疾病的潜力，除了已建立的全身和局部治疗方法，但外科医生必须警惕肝脏质量差和肝切除术后肝功能衰竭（PHLF）的幽灵。音量调制,一代人肝脏手术的基石，随着肝静脉耗竭（LVD）的出现，已在手臂上进行了一次注射，以确保未来的肝脏残留物（FLR）明显肥大。对于那些患有同步疾病的患者，肝切除的最佳时机尚未真正建立。但有证据表明,那些需要复杂结直肠手术和肝脏大切除的患者最好采用分阶段治疗.在手术室里,保留实质的微创手术（MIS）可以显着减少对患者的手术损伤，并导致更好的围手术期结果，更快地返回功能。
