대장 직장암 간전이의 외과적 치료

Abstract

The optimal management of hepatic metastases in colorectal carcinoma patients has becomeincreasingly complex with the myriad of available treatment options. Because the timing of anytherapy has become integral to the success of the treatment, a collaborative approach involvingmultiple specialties is needed for achieving the best patient outcome. Surgical resection is themost effective therapy for metastatic colorectal cancer isolated to the liver. Liver resection ofcolorectal metastases is associated with three- and five-year survival rates close to 40~60% and30~50%, respectively.Because the technique for hepatic resection has improved, patients with multiple, biloba, andhuge metastases can undergo resection. Every liver resection should be planned afterintraoperative ultrasonography, and an anatomical surgical procedure should be preferredinstead of wedge resection.Since some of patients diagnosed with metastatic colorectal disease are initially classified asunresectable, neoadjuvant chemotherapy is being increasingly employed to downsize colorectalmetastasis. The greatest benefit of the preoperative approach is the potential to convert patientswith initially unresectable metastatic disease to a resectable state.Although various prognostic risk factors have been identified, there has been no dependablestaging or prognostic scoring system for metastatic hepatic tumor. As surgeons become moreproficient in the technical aspects of resection, the patient selection criteria as based on thebiologic determinants of the outcome are becoming increasingly important.The goal of this review is to provide the optimal management, treatment and follow-up forpatients with colorectal metastasis to the liver.