Current state of surgical treatment of liver metastases from colorectal cancer

来源 :World Journal of Gastrointestinal Surgery | 被引量 : 0次 | 上传用户:magihao
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
Hepatic resection is the procedure of choice for curative treatment of colorectal liver metastases(CLM).Objectives of surgical strategy are low intraoperative blood loss,short liver ischemic times and minor postoperative morbidity and mortality.Blood loss is an independent predictor of mortality and compromises,in common with postoperative complications,long-term outcome after hepatectomy for CLM.The type of liver resection has no impact on the outcome of patients with CLM;wedge resections are not inferior to anatomical resections in terms of tumor clearance,pattern of recurrence or survival.Despite the lack of proof of survival benef it,routine lymphadenectomy has been advocated,allowing the detection of microscopic lymph node metastases and with prognostic value.In experienced hands,minimally invasive liver surgery is safe with acceptable morbidity and mortality and oncological results comparable to open hepatic surgery,but with reduced blood loss and earlier recovery.The European Colorectal Metastases Treatment Group recommended treating up front with chemotherapy for patients with both resectable and unresectable CLM.However,neoadjuvant chemotherapy can induce damage to the remnant liver,dependent on the number of chemotherapy cycles.Therefore,in our opinion,preoperative chemotherapy should be reserved for patients whose CLM are marginally resectable or unresectable.A meta analysis of randomized trials dealing with perioperative chemotherapy for the treatment of resectable CLM demonstrated a benefit of systemic chemotherapy but did not answer the question of whether a neoadjuvant or adjuvant approach should be preferred.Analysis of the literature demonstrates that the results of specialized centers cannot be attained in the reality of comprehensive patient care.Reasons behind the commonly poorer results seen in cancer networks as compared with literature-based data are,on the one hand,geographical disparities in access to specialized surgical and medical care.On the other hand,a selection bias in the reports of the literature may be assumed.Studies of surgical resection for CLM derive almost exclusively from case series generally drawn from large academic centers where patient selection or surgical expertise is superior to what is found in many communities.Therefore,we may conclude that the comprehensive propagation of the standards outlined in this paper constitutes a major task in the near future to reduce the variations in survival of patients with CLM. Hepatic resection is the procedure of choice for curative treatment of colorectal liver metastases (CLM). Objectives of surgical strategies are low intraoperative blood loss, short liver ischemic times and minor postoperative morbidity and mortality. Blood loss is an independent predictor of mortality and compromises, in common with postoperative complications, long-term outcome after hepatectomy for CLM. type of liver resection has no impact on the outcome of patients with CLM; wedge resections are not inferior to anatomical resections in terms of tumor clearance, pattern of recurrence or survival .Despite the lack of proof of survival benefit it, routine detection of microscopic lymph node metastases and with prognostic value. In hands, minimally invasive liver surgery is safe with acceptable morbidity and mortality and oncological results comparable to open hepatic surgery, but with reduced blood loss and earlier recovery. European Co lorectal Metastases Treatment Group recommended treating up front with chemotherapy for patients with both resectable and unresectable CLM. Even, neoadjuvant chemotherapy can induce damage to the remnant liver, dependent on the number of cycles of chemotherapy. Beforefore, in our opinion, preoperative chemotherapy should be reserved for patient whose CLM are marginally resectable or unresectable. A meta analysis of randomized trials dealing with perioperative chemotherapy for the treatment of resectable CLM demonstrated a benefit of systemic chemotherapy but did not answer the question of whether a neoadjuvant or adjuvant approach should be preferred. Analysis of the literature demonstrates that the results of specialized centers can not be attained in the reality of comprehensive patient care. Reasons behind the commonly poorer results seen in cancer networks as compared with literature-based data are, on the one hand, geographical disparities in access to specialized surgical and medical care.Onthe other hand, a selection bias in the reports of the literature may be assumed. Situations of surgical resection for CLM derive almost exclusively from case series series generally drawn from large academic centers where patient selection or surgical expertise is superior to what is found in many communities Before you, we may conclude that the comprehensive propagation of the standards outlined in this paper constitutes a major task in the near future to reduce the variations in survival of patients with CLM.
其他文献
目的:分析单孔腹腔镜手术对卵巢囊肿蒂扭转患儿的疗效.方法:对本院2017.01- 2017.12 收治的卵巢囊肿蒂扭转共 3 5 例患儿的临床资料开展回顾性分析,均行单孔腹腔镜手术,同时
目的:探讨采用胎儿畸形超声筛查在产前诊断中的应用.方法:选取本院2017 年10 月至2018 年10 月期间一共收录产前检查的孕妇总计为 120 例,孕育周期为 22-28 周,作为此次的研
请下载后查看,本文暂不支持在线获取查看简介。 Please download to view, this article does not support online access to view profile.
中国油画意境既须要具备庄子的空灵无欲;又要得屈原的超然物外,要去深入感悟众生的心。中国油画意境的创作是要透过鸿蒙之理,去表现画面的点、线、面以及光、影、色、形、字
2015年6月28日到7月12日,我等一行22人参加江苏省委宣传部组织的“全省人文社科精英人才德国高级研修班”来到德国进行学术与艺术交流,重点考察了法兰克福、特利尔、哥廷根、柏林等城市。就艺术收获而言,以哥廷根、柏林的感受最深,得到的画稿多达30余幅,留下的文字有2万有余,故堪称笔尖下的德国之行。  2015年7月2日到3日,我们来到哥廷根大学朝圣,在这所世界著名的大学待了两天,重温季羡林先生在这
艺术家雕塑理念的变化与材料的发展极大地改变了当代雕塑材料课程的教学模式,其在我国当前雕塑教学体系中的重要性也越来越明显。本文首先对材料课程的目的和教学内容作了简
北京奥运会之后,中国的焦点渐渐转到上海世博会上。在2010年上海世博会开幕迎来倒计时600天之际,上海市从7月到9月先后发布了《迎世博加强市容环境建设和管理600天行动计划纲
请下载后查看,本文暂不支持在线获取查看简介。 Please download to view, this article does not support online access to view profile.
油画教育在中国的各大高校都已经非常普遍了,油画的教育可以从两个根本的方向上进行。第一是从西方传统绘画中吸取养分,它包括对素描的学习和对油画传统技法的学习;第二是从
罗奇以其独有的虚幻朦胧的绘画风格,在油画的西洋面孔下传承着中国绘画传统的人文主义关怀,他刻画了当下物欲横流时代的灵魂肖像,诠释着画家对这个世界的解读。 With his un