Treatment strategies for colorectal carcinoma with synchronous liver metastases: Which way to go?

作     者：Peter Ihnát Petr Vávra Pavel Zonca 

作者机构：Department of Surgical StudiesFaculty of MedicineUniversity of Ostrava Department of SurgeryUniversity Hospital Ostrava 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2015年第21卷第22期

页      面：7014-7021页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Colorectal cancer Liver-first approach Reverse strategy Simultaneous resection Up-fronthepatectomy 

摘      要：AIM: To offer an up-to-date review of all availabletreatment strategies for patients with synchronous colorectal liver metastases(CLM).METHODS: A comprehensive literature search was performed to identify articles related to the management of patients with synchronous CLM. A search of the electronic databases PubMed, MEDLINE, and Google Scholar was conducted in September *** following search terms were used: synchronous colorectal liver metastases, surgery, stage Ⅳ colorectal cancer, liver-first approach, and up-front *** terms were employed in various combinations to maximize the search. Only articles written in English were included. Particular attention was devoted to studies and review articles that were published within the last six years(2009-2014). Additional searches of the cited references from primary articles were performed to further improve the review. The full texts of all relevant articles were accessed by two independent ***: Poor long-term outcomes of patients with synchronous CLM managed by a traditional treatment strategy have led to questions about the timing and sequence of possible therapeutic interventions. Thus,alternative paradigms called reverse strategies have been proposed. Presently, there are four treatment strategies available:(1) primary first approach(or traditional approach) comprises resection of the primary colorectal tumor followed by chemotherapy;subsequent liver resection is performed 3-6 mo after colorectal resection(provided that CLM are still resectable);(2) simultaneous resection of the primary colorectal tumor and CLM during a single operation presents intriguing options for a highly select group of patients, which can be associated with significant postoperative morbidity;(3) liver-first(or chemotherapy-first) approach comprises preoperative chemotherapy(3-6 cycles) followed by liver resection,adjuvant chemotherapy, and resection of the primary colorectal tumor(it is best suited for patient