1. 切除仍然是金标准 2. 不可切除病灶
5. 直径＜3.5~5cm （1）主要包括两个适应症： （2）不可切除性肝转移病灶的姑息治疗和肝转移病灶的根治性消融 （3）转化治疗？部分消融+部分根治性切除？ 介入治疗适应症相关：结直肠癌肝转移射频消融相关的自然病史 为什么说切除是金标准？ 外科局部治疗（结直肠癌肝转移）：【1】 46项研究（9934例），随访17~99个月。8485例 外科肝切除。1149例根治性肿瘤消融，有或没有同时肝切除。 5年生存率： （1）全部病人为7%~58%，中位生存期36%。 （2）1~3个转移病灶，五年生存期为25.9%~50%，中位生存期39%。 （3）≥4个病灶，5年生存期0%~53%，中为生存期为17.1% Local ablative treatment improves survival? 【2】
Comparison between local ablative therapy and chemotherapy for non-resectable colorectal liver metastases: a prospective study.【2】
Although overall survival did not reached statistical significance, the median DFS of 9 months suggests a beneficial effect of local tumour ablation for non-resectable colorectal liver metastases. Moreover, compared with systemic chemotherapy more QALY's were gained after local ablative therapy. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases.【3】
Hepatic resection is the treatment of choice for colorectal liver metastases. RFA alone or in combination with resection for unresectable patients does not provide survival comparable to resection, and provides survival only slightly superior to nonsurgical treatment. 1. Smith MD, McCall JL.Systematic review of tumour number and outcome after radical treatment of colorectal liver metastases. Br J Surg. 2009 Oct;96(10):1101-13. doi: 10.1002/bjs.6735. 2. Ruers TJ, Joosten JJ, Wiering B, Langenhoff BS, Dekker HM, Wobbes T, Oyen WJ, Krabbe PF, Punt CJ. Comparison between local ablative therapy and chemotherapy for non-resectable colorectal liver metastases: a prospective study. Ann Surg Oncol. 2007 Mar;14(3):1161-9. Epub 2006 Dec 31. 3. Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004 Jun;239(6):818-25; discussion 825-7. | ||||||||||||||||||||||||||
