大肠癌肝转移综合治疗进展.pptVIP

Liver Metastases of Colorectal Cancer :Where are we standing in current practice ? 15~25％ patients with primary CRC present with synchronous liver metastases An additional 20% will develop metachronous hepatic secondaries 20% are candidates for curative resection of liver metastases Prognostic Factors after R0-resection (Ｉ) Demographic features: gender, age Primary tumor: LN involvement, size, differentiation, staging and location( esp in sychronous metastases) Metastases: multiplicity of lesions and the intrahepatic tumor distribution? Satellite metastases Size of tumor Histopatholigical features Synchronous and metachronous metastases Prognostic Factors after R0-resection (Ⅱ) Therapeutic approach Others: PS, weight loss, serum albumin , preoperative CEA, tumor ploidy, oncogen/oncosupressor gene expression, etc. Surgeon performing the operation Risk Factors Relative Risk Primary tumor : serosa + 1.4 Primary tumor : N+ 1.5 Delay (primary to metastase) 2 years 1.4 Number of metastases 3 1.6 Resection clearance 1 cm 1.4 Size of metastases 5cm 1.3 Age 60 yrs 1.2 Plasma CEA 30 ng/ml 2.2 Contraindications to CRC Liver Metastases Radical(R0) resection not possible but: occasionally justified for symptomatic palliation ( RARE！) Lymph nodes metastases at the liver hilum but: anecdotal success reported by Nakamura, 1992 Extrahepatic tumor except for direct invasion of adjacent structures, local recurrence, and a solitary ( 1~3?）lung metastases Factors Contributing to the Improved Results of Liver Metastases of CRC 肝脏外科技术的提高 一些新的辅助/姑息治疗手段的出现 术前影像诊断技术的改进 多中心、大规模临床总结的发表 Preoperative Investigation The primary tumor site The extent of liver involvement The presence of extrahepatic disease Markers to provide a baseline for follow-up Timing Of Liver Resection a