The incidence of colorectal cancer and colorectal liver metastases (CRLM) is increasing globally due to an interaction of environmental and genetic factors. A minority of patients with CRLM have surgically resectable disease, but for those who have resection as part of multimodal therapy for their disease, long-term survival has been shown. Precision surgery—the idea of careful patient selection and targeting of surgical intervention, such that treatments shown to be proven to benefit on a population level are the optimal treatment for each individual patient—is the new paradigm of care. Key to this is the understanding of tumour molecular biology and clinically relevant mutations, such as KRAS, BRAF, and microsatellite instability (MSI), which can predict poorer overall outcomes and a poorer response to systemic therapy. The emergence of immunotherapy and hepatic artery infusion (HAI) pumps show potential to convert previously unresectable disease to resectable disease, in addition to established systemic and locoregional therapies, but the surgeon must be wary of poor-quality livers and the spectre of post-hepatectomy liver failure (PHLF). Volume modulation, a cornerstone of hepatic surgery for a generation, has been given a shot in the arm with the advent of liver venous depletion (LVD) ensuring significantly more hypertrophy of the future liver remnant (FLR). The optimal timing of liver resection for those patients with synchronous disease is yet to be truly established, but evidence would suggest that those patients requiring complex colorectal surgery and major liver resection are best served with a staged approach. In the operating room, parenchyma-preserving minimally invasive surgery (MIS) can dramatically reduce the surgical insult to the patient and lead to better perioperative outcomes, with quicker return to function.
结直肠癌及结直肠癌肝转移（CRLM）的发病率在全球范围内因环境与遗传因素的相互作用而持续上升。仅有少数CRLM患者适合接受手术切除，但对于那些将切除术作为多模式治疗方案一部分的患者，研究已证实其可获得长期生存。精准外科——即通过精细的患者筛选和手术干预靶向化，使在群体层面证明有效的治疗方案成为每位患者的最佳选择——已成为新的诊疗范式。其核心在于理解肿瘤分子生物学及临床相关基因突变，如KRAS、BRAF和微卫星不稳定性（MSI），这些因素可预示患者总体预后较差且对全身治疗反应不佳。除已确立的全身治疗和局部治疗外，免疫疗法与肝动脉灌注泵（HAI）的出现，为将既往不可切除病灶转化为可切除病灶提供了可能，但外科医生需警惕肝功能储备不足及肝切除术后肝衰竭（PHLF）的风险。作为肝脏外科数十年来基石的体积调控技术，因肝静脉剥夺术（LVD）的应用而焕发新生，该技术能显著促进未来剩余肝脏（FLR）的增生肥大。对于同时性肝转移患者，最佳肝切除时机尚未完全明确，但证据表明需要复杂结直肠手术联合大范围肝切除的患者，更适合采用分阶段治疗方案。在手术室中，保留实质的微创外科（MIS）能显著减轻手术创伤，改善围手术期预后，并加速患者功能恢复。
Challenges and Opportunities for Precision Surgery for Colorectal Liver Metastases
肿瘤(癌症)患者之家