摘要：肝脏是结直肠癌血行转移最主要的靶器官，约有15%~25%结直肠癌患者在确诊时即合并有肝转移，而另有15%~25%的患者将在结直肠癌原发灶根治术后发生肝转移，其中绝大多数的肝转移灶初始无法获得根治性切除。我们特邀日本国立国际医疗研究中心的Nobuyuki Tak

肝脏是结直肠癌血行转移最主要的靶器官，约有15%~25%结直肠癌患者在确诊时即合并有肝转移，而另有15%~25%的患者将在结直肠癌原发灶根治术后发生肝转移，其中绝大多数的肝转移灶初始无法获得根治性切除。我们特邀日本国立国际医疗研究中心的Nobuyuki Takemura教授为我们解析结直肠肝转移同时伴门淋巴结转移患者的诊疗经验。

《肿瘤瞭望消化时讯》临床难治性和复发性肝转移性结直肠癌的治疗目前面临哪些挑战？

Takemura 医生：首先，最重要的是再次对复发性结直肠肝转移灶进行治疗，特别是注重局部治疗，应该将手术作为第一要务，其次是消融治疗。对于早期复发的患者，我们一般会在手术前进行化疗。最关键的是再次手术或尽可能广泛地切除肝转移灶。初始肝切除术基本上是部分切除，而不是大范围肝切除术。

Dr Takemura: Firstly, the most important thing is repeat treatment for the recurrent colorectal liver metastases, especially focusing on local treatment, including surgery as the first priority, second is ablation therapy. For those patients with early recurrence, we perform chemotherapy before surgery. Repeating surgery or repeating hepatectomy as extensively as possible is the most important issue. Initial hepatectomy basically involves partial resection, not major hepatectomy.

《肿瘤瞭望消化时讯》对于门静脉淋巴结转移的结直肠癌患者，淋巴结清扫术的治疗价值是什么？

Takemura 医生：结直肠癌引起的门静脉淋巴结转移首先起源于结直肠区域，然后转移到肝。之后，再从肝脏转移到门静脉区，因此是第三次转移。最初，我们推荐化疗，但对于化疗后门静脉淋巴结转移有限的患者，我们偶尔会同时进行肝切除和门静脉转移淋巴结切除。当我们进行化疗时，如果肿瘤进展，我们不推荐进行肝切除术，但对于化疗有反应且肝脏病变没有新发局部复发的患者，我们会在切除淋巴结的同时进行肝切除术。在这些情况下，一些患者的生存可以长达五年。

Dr Takemura: Portal lymph node metastases from colorectal cancer metastases is originated first in colorectal region and then metastasize to the liver. After that, metastases occur in the portal region from the liver metastases, so it is the third metastases. Initially, we recommended chemotherapy, but for those with limited portal lymph node metastases after chemotherapy, we occasionally do concurrent resection of hepatectomy and removal of higher lymph node metastases as long as chemotherapy was effective. When we perform chemotherapy and if the tumor progresses, we do not recommend hepatectomy, but for patients who respond to chemotherapy with no new regional recurrence of hepatic lesions, we perform hepatectomy concurrent with lymph node removal. Some of the patients survive for up to five years in these situations.

《肿瘤瞭望消化时讯》关于结肠癌肝转移患者的全身治疗策略，您可以分享一下治疗经验吗？

Takemura 医生：在肝切除术和全身治疗之间，我们的首要任务是肝切除术，因为结直肠癌的各种指南都建议对可切除的结直肠癌肝转移进行肝切除术。为了能够顺利进行肝切除术，适当使用全身治疗也很重要。如果患者存在 2 ~3 个肝脏的小病灶，此时化疗可以使肝脏的小病灶缩小到难以检测的程度，因此治疗组合和时机非常重要。

Dr Takemura: Between hepatectomy and systemic therapy, our first priority is for hepatectomy, because there are various guidelines for treating colorectal cancer recommend that hepatectomy for resectable colorectal liver metastases. The first priority is put on surgical removal. In order to perform hepatectomy, the appropriate use of systemic therapy is important. If there are two or three small hepatic lesions, if we use chemotherapy, these lesions can disappear, and in these circumstances, using chemotherapy can lead to hepatic small lesions becoming non-detectable in the short term. So the combination and timing is very important.

来源：肿瘤瞭望消化时讯