大腸癌肝転移に対する外科治療update
大腸がん肝転移に対する標準治療は肝切除である．安全な肝切除には術前の正確な肝機能と残肝容量の評価が必須である．再発に対する繰り返し切除を意識し，肝実質をできるだけ温存する部分切除を基本に切除計画を立てる．残肝容量が不足でも門脈塞栓術，二期的切除，ALPPS手術，肝静脈再建などを駆使し，安全かつ治癒的な肝切除が可能である．術後の高再発率は依然問題だが，再発抑制には補助化学療法が有用で，再発すれば再肝切除を考慮する．切除不能例には分子標的薬を含む強力な化学療法により，conversionを狙う治療方針が合理的である．...
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| Published in | 日本臨床外科学会雑誌 Vol. 78; no. 1; pp. 1 - 10 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2017
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.78.1 |
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| Abstract | 大腸がん肝転移に対する標準治療は肝切除である．安全な肝切除には術前の正確な肝機能と残肝容量の評価が必須である．再発に対する繰り返し切除を意識し，肝実質をできるだけ温存する部分切除を基本に切除計画を立てる．残肝容量が不足でも門脈塞栓術，二期的切除，ALPPS手術，肝静脈再建などを駆使し，安全かつ治癒的な肝切除が可能である．術後の高再発率は依然問題だが，再発抑制には補助化学療法が有用で，再発すれば再肝切除を考慮する．切除不能例には分子標的薬を含む強力な化学療法により，conversionを狙う治療方針が合理的である． |
|---|---|
| AbstractList | 大腸がん肝転移に対する標準治療は肝切除である．安全な肝切除には術前の正確な肝機能と残肝容量の評価が必須である．再発に対する繰り返し切除を意識し，肝実質をできるだけ温存する部分切除を基本に切除計画を立てる．残肝容量が不足でも門脈塞栓術，二期的切除，ALPPS手術，肝静脈再建などを駆使し，安全かつ治癒的な肝切除が可能である．術後の高再発率は依然問題だが，再発抑制には補助化学療法が有用で，再発すれば再肝切除を考慮する．切除不能例には分子標的薬を含む強力な化学療法により，conversionを狙う治療方針が合理的である． |
| Author | 長谷川, 潔 |
| Author_xml | – sequence: 1 fullname: 長谷川, 潔 organization: 東京大学大学院医学系研究科臓器病態外科学肝胆膵外科 |
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| Copyright | 2017 日本臨床外科学会 |
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| References | 35) Hasegawa K, Saiura A, Takayama T, et al : Adjuvant Oral Uracil-Tegafur with Leucovorin for Colorectal Cancer Liver Metastases : A Randomized Controlled Trial. PLoS One 2016 ; 11 : e0162400 2) Kubota K, Makuuchi M, Kusaka K, et al : Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 1997 ; 26 : 1176-1181 19) Oba M, Hasegawa K, Shindoh J, et al : Survival benefit of repeat surgeries for successive recurrences after the initial hepatic resection for colorectal liver metastases. Surgery 2016 ; 159 : 632-640 22) Rees M, Tekkis PP, Welsh FK, et al : Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer : a multifactorial model of 929 patients. Ann Surg 2008 ; 247 : 125-135 6) Adam R, Laurent A, Azoulay D, et al : Two-stage hepatectomy : a planned strategy to treat irresectable liver tumors. Ann Surg 2000 ; 232 : 777-785 31) Nordlinger B, Sorbye H, Glimelius B, et al : Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983) : long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol 2013 ; 14 : 1208-1215 26) Vauthey JN, Zimmitti G, Kopetz SE, et al : RAS mutation status predicts survival and patterns of recurrence in patients undergoing hepatectomy for colorectal liver metastases. Ann Surg 2013 ; 258 : 619-626 30) Nordlinger B, Sorbye H, Glimelius B, et al : Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983) : a randomised controlled trial. Lancet 2008 22 ; 371 : 1007-1016 33) Mitry E, Fields AL, Bleiberg H, et al : Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer : a pooled analysis of two randomized trials. J Clin Oncol 2008 ; 26 : 4906-4911 3) Takamoto T, Hashimoto T, Sano K, et al : Recovery of liver function after the cessation of preoperative chemotherapy for colorectal liver metastasis. Ann Surg Oncol 2010 ; 17 : 2747-2755 7) Schnitzbauer AA, Lang SA, Goessmann H, et al : Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 2012 ; 255 : 405-414 14) Andres A, Toso C, Adam R, et al : A survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases : a LiverMetSurvey-based study. Ann Surg 2012 ; 256 : 772-778 32) Portier G, Elias D, Bouche O, et al : Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases : FFCD ACHBTH AURC 9002 trial. J Clin Oncol 2006 ; 24 : 4976-4982 4) Pawlik TM, Choti MA : Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg 2007 ; 11 : 1057-1077 11) Kawaguchi Y, Ishizawa T, Miyata Y, et al : Portal uptake function in veno-occlusive regions evaluated by real-time fluorescent imaging using indocyanine green. J Hepatol 2013 ; 58 : 247-253 9) Sakamoto Y, Inagaki F, Omichi K, et al : Associated Liver Partial Partition and Trans-Ileocecal Portal Vein Embolization for Staged Hepatectomy. Ann Surg 2016 ; 264 : e21-e22 12) Mise Y, Hasegawa K, Satou S, et al : Venous reconstruction based on virtual liver resection to avoid congestion in the liver remnant. Br J Surg 2011 ; 98 : 1742-1751 13) Yoshioka R, Hasegawa K, Mise Y, et al : Evaluation of the safety and efficacy of simultaneous resection of primary colorectal cancer and synchronous colorectal liver metastases. Surgery 2014 ; 155 : 478-485 34) Ychou M, Hohenberger W, Thezenas S, et al : A randomized phase III study comparing adjuvant 5-fluorouracil/folinic acid with FOLFIRI in patients following complete resection of liver metastases from colorectal cancer. Ann Oncol 2009 ; 20 : 1964-1970 18) Oba M, Hasegawa K, Matsuyama Y, et al : Discrepancy between recurrence-free survival and overall survival in patients with resectable colorectal liver metastases : a potential surrogate endpoint for time to surgical failure. Ann Surg Oncol 2014 ; 21 : 1817-1824 8) Yamashita S, Hasegawa K, Takahashi M, et al : One-stage hepatectomy following portal vein embolization for colorectal liver metastasis. World J Surg 2013 ; 37 : 622-628 5) von Heesen M, Schuld J, Sperling J, et al : Parenchyma-preserving hepatic resection for colorectal liver metastases. Langenbecks Arch Surg 2012 ; 397 : 383-395 28) Van Cutsem E, Cervantes A, Adam R, et al : ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016 ; 27 : 1386-1422 16) Adam R, Pascal G, Azoulay D, et al : Liver resection for colorectal metastases : the third hepatectomy. Ann Surg 2003 ; 238 : 871-883 21) Nordlinger B, Guiguet M, Vaillant JC, et al : Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 1996 ; 77 : 1254-1262 25) Beppu T, Sakamoto Y, Hasegawa K, et al : A nomogram predicting disease-free survival in patients with colorectal liver metastases treated with hepatic resection : multicenter data collection as a Project Study for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 2012 ; 19 : 72-84 1) 大腸癌研究会/編:大腸癌治療ガイドライン 医師用 2014年版．金原出版，東京，2014 10) Hosokawa I, Allard MA, Gelli M, et al : Long-Term Survival Benefit and Potential for Cure after R1 Resection for Colorectal Liver Metastases. Ann Surg Oncol 2016 ; 23 : 1897-1905 15) Takahashi M, Hasegawa K, Oba M, et al : Repeat resection leads to long-term survival : analysis of 10-year follow-up of patients with colorectal liver metastases. Am J Surg 2015 ; 210 : 904-910 24) Iwatsuki S, Dvorchik I, Madariaga JR, et al : Hepatic resection for metastatic colorectal adenocarcinoma : a proposal of a prognostic scoring system. J Am Coll Surg 1999 ; 189 : 291-299 23) Zakaria S, Donohue JH, Que FG, et al : Hepatic resection for colorectal metastases : value for risk scoring systems? Ann Surg 2007 ; 246 : 183-191 27) Folprecht G, Gruenberger T, Bechstein WO, et al : Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab : the CELIM randomised phase 2 trial. Lancet Oncol 2010 ; 11 : 38-47 20) Fong Y, Fortner J, Sun RL, et al : Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer : analysis of 1001 consecutive cases. Ann Surg 1999 ; 230 : 309-318 29) Benson AB 3rd, Venook AP, Bekaii-Saab T, et al : NCCN Clinical Practice Guidelines in Oncology Colon Cancer V.2.2015. (Accessed October 31, 2016, at https://www.tri-kobe.org/nccn/guideline/colorectal/index.html)筆者註:NCCNのHPから入手可能だが，有料である．ただし，臨床研究情報センターのHPにて英語版および日本語版を無料で閲覧できる 17) de Jong MC, Pulitano C, Ribero D, et al : Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis : an international multi-institutional analysis of 1669 patients. Ann Surg 2009 ; 250 : 440-448 |
| References_xml | – reference: 10) Hosokawa I, Allard MA, Gelli M, et al : Long-Term Survival Benefit and Potential for Cure after R1 Resection for Colorectal Liver Metastases. Ann Surg Oncol 2016 ; 23 : 1897-1905 – reference: 12) Mise Y, Hasegawa K, Satou S, et al : Venous reconstruction based on virtual liver resection to avoid congestion in the liver remnant. Br J Surg 2011 ; 98 : 1742-1751 – reference: 21) Nordlinger B, Guiguet M, Vaillant JC, et al : Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 1996 ; 77 : 1254-1262 – reference: 2) Kubota K, Makuuchi M, Kusaka K, et al : Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 1997 ; 26 : 1176-1181 – reference: 35) Hasegawa K, Saiura A, Takayama T, et al : Adjuvant Oral Uracil-Tegafur with Leucovorin for Colorectal Cancer Liver Metastases : A Randomized Controlled Trial. PLoS One 2016 ; 11 : e0162400 – reference: 6) Adam R, Laurent A, Azoulay D, et al : Two-stage hepatectomy : a planned strategy to treat irresectable liver tumors. Ann Surg 2000 ; 232 : 777-785 – reference: 9) Sakamoto Y, Inagaki F, Omichi K, et al : Associated Liver Partial Partition and Trans-Ileocecal Portal Vein Embolization for Staged Hepatectomy. Ann Surg 2016 ; 264 : e21-e22 – reference: 34) Ychou M, Hohenberger W, Thezenas S, et al : A randomized phase III study comparing adjuvant 5-fluorouracil/folinic acid with FOLFIRI in patients following complete resection of liver metastases from colorectal cancer. Ann Oncol 2009 ; 20 : 1964-1970 – reference: 29) Benson AB 3rd, Venook AP, Bekaii-Saab T, et al : NCCN Clinical Practice Guidelines in Oncology Colon Cancer V.2.2015. (Accessed October 31, 2016, at https://www.tri-kobe.org/nccn/guideline/colorectal/index.html)筆者註:NCCNのHPから入手可能だが，有料である．ただし，臨床研究情報センターのHPにて英語版および日本語版を無料で閲覧できる． – reference: 15) Takahashi M, Hasegawa K, Oba M, et al : Repeat resection leads to long-term survival : analysis of 10-year follow-up of patients with colorectal liver metastases. Am J Surg 2015 ; 210 : 904-910 – reference: 27) Folprecht G, Gruenberger T, Bechstein WO, et al : Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab : the CELIM randomised phase 2 trial. Lancet Oncol 2010 ; 11 : 38-47 – reference: 30) Nordlinger B, Sorbye H, Glimelius B, et al : Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983) : a randomised controlled trial. Lancet 2008 22 ; 371 : 1007-1016 – reference: 16) Adam R, Pascal G, Azoulay D, et al : Liver resection for colorectal metastases : the third hepatectomy. Ann Surg 2003 ; 238 : 871-883 – reference: 23) Zakaria S, Donohue JH, Que FG, et al : Hepatic resection for colorectal metastases : value for risk scoring systems? Ann Surg 2007 ; 246 : 183-191 – reference: 11) Kawaguchi Y, Ishizawa T, Miyata Y, et al : Portal uptake function in veno-occlusive regions evaluated by real-time fluorescent imaging using indocyanine green. J Hepatol 2013 ; 58 : 247-253 – reference: 19) Oba M, Hasegawa K, Shindoh J, et al : Survival benefit of repeat surgeries for successive recurrences after the initial hepatic resection for colorectal liver metastases. Surgery 2016 ; 159 : 632-640 – reference: 25) Beppu T, Sakamoto Y, Hasegawa K, et al : A nomogram predicting disease-free survival in patients with colorectal liver metastases treated with hepatic resection : multicenter data collection as a Project Study for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 2012 ; 19 : 72-84 – reference: 8) Yamashita S, Hasegawa K, Takahashi M, et al : One-stage hepatectomy following portal vein embolization for colorectal liver metastasis. World J Surg 2013 ; 37 : 622-628 – reference: 33) Mitry E, Fields AL, Bleiberg H, et al : Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer : a pooled analysis of two randomized trials. J Clin Oncol 2008 ; 26 : 4906-4911 – reference: 1) 大腸癌研究会/編:大腸癌治療ガイドライン 医師用 2014年版．金原出版，東京，2014 – reference: 7) Schnitzbauer AA, Lang SA, Goessmann H, et al : Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 2012 ; 255 : 405-414 – reference: 26) Vauthey JN, Zimmitti G, Kopetz SE, et al : RAS mutation status predicts survival and patterns of recurrence in patients undergoing hepatectomy for colorectal liver metastases. Ann Surg 2013 ; 258 : 619-626 – reference: 28) Van Cutsem E, Cervantes A, Adam R, et al : ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016 ; 27 : 1386-1422 – reference: 5) von Heesen M, Schuld J, Sperling J, et al : Parenchyma-preserving hepatic resection for colorectal liver metastases. Langenbecks Arch Surg 2012 ; 397 : 383-395 – reference: 22) Rees M, Tekkis PP, Welsh FK, et al : Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer : a multifactorial model of 929 patients. Ann Surg 2008 ; 247 : 125-135 – reference: 4) Pawlik TM, Choti MA : Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg 2007 ; 11 : 1057-1077 – reference: 18) Oba M, Hasegawa K, Matsuyama Y, et al : Discrepancy between recurrence-free survival and overall survival in patients with resectable colorectal liver metastases : a potential surrogate endpoint for time to surgical failure. Ann Surg Oncol 2014 ; 21 : 1817-1824 – reference: 14) Andres A, Toso C, Adam R, et al : A survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases : a LiverMetSurvey-based study. Ann Surg 2012 ; 256 : 772-778 – reference: 32) Portier G, Elias D, Bouche O, et al : Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases : FFCD ACHBTH AURC 9002 trial. J Clin Oncol 2006 ; 24 : 4976-4982 – reference: 24) Iwatsuki S, Dvorchik I, Madariaga JR, et al : Hepatic resection for metastatic colorectal adenocarcinoma : a proposal of a prognostic scoring system. J Am Coll Surg 1999 ; 189 : 291-299 – reference: 17) de Jong MC, Pulitano C, Ribero D, et al : Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis : an international multi-institutional analysis of 1669 patients. Ann Surg 2009 ; 250 : 440-448 – reference: 3) Takamoto T, Hashimoto T, Sano K, et al : Recovery of liver function after the cessation of preoperative chemotherapy for colorectal liver metastasis. Ann Surg Oncol 2010 ; 17 : 2747-2755 – reference: 13) Yoshioka R, Hasegawa K, Mise Y, et al : Evaluation of the safety and efficacy of simultaneous resection of primary colorectal cancer and synchronous colorectal liver metastases. Surgery 2014 ; 155 : 478-485 – reference: 20) Fong Y, Fortner J, Sun RL, et al : Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer : analysis of 1001 consecutive cases. Ann Surg 1999 ; 230 : 309-318 – reference: 31) Nordlinger B, Sorbye H, Glimelius B, et al : Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983) : long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol 2013 ; 14 : 1208-1215 |
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| Title | 大腸癌肝転移に対する外科治療update |
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