臨床外科62巻9号

2007年09月発行

特集 多発肝転移をめぐって

大腸癌多発肝転移に対する合理的治療体系

著者： 吉留博之¹ 木村文夫¹ 清水宏明¹ 大塚将之¹ 加藤厚¹ 吉富秀幸¹ 野沢聡志¹ 古川勝規¹ 三橋登¹ 竹内男¹ 須田浩介¹ 宮崎勝¹

所属機関： ¹千葉大学大学院医学研究院臓器制御外科学

ページ範囲：P.1225 - P.1230

要旨：大腸癌多発肝転移に対する合理的治療戦略においては肝切除を中心に置き，その適応を考慮することが重要である．肝予備能の評価と癌の進展度から切除適応を決定し，残肝容積増大のための門脈塞栓術やラジオ波などのablation治療や，FOLFOX，FOLFIRIなどの抗癌剤治療を組み合わせて切除例数を増加させ，予後の向上をはかることが重要である．そのほかの胃癌などにおける多発肝転移例では厳格な患者選択が重要である．

参考文献

1）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 Frarcaise Chirurgie. Cancer 77：1254-1262, 1996

2）Fong Y, Cohen AM, Fortner JG, et al：Liver resection for colorectal metastases. J Clin Oncol 15：938-946, 1997

3）Minagawa M, Makuuchi M, Torzilli G, et al：Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer：long-term results. Ann Surg 231：487-499, 2000

4）Yamamoto J, Shimada K, Kosuge T, et al：Factors influencing survival of patients undergoing hepatectomy for colorectal metastases. Br J Surg 86：332-337, 1999

5）Miyazaki M, Ito H, Nakagawa K, et al：Aggressive surgical resection for hepatic metastases involving the inferior vena cava. Am J Surg 177：294-298, 1999

6）Hemming AW, Reed AI, Langham MR Jr, et al：Combined resection of the liver and inferior vena cava for hepatic malignancy. Ann Surg 239：712-719, 2004

7）Douillard JY, Cunningham D, Roth AD, et al：Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer：a multicentre randomised trial. Lancet 355：1372, 2000

8）Tournigand C, Andre T, Achille E, et al：FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer：a randomized GERCOR study. J Clin Oncol 22：229-237, 2004

9）de Gramont A, Figer A, Seymour M, et al：Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18：2938-2947, 2000

10）Azoulay D, Castaing D, Smail A, et al：Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 231：480-486, 2000

11）Abdalla EK, Vauthey JN, Ellis LM, et al：Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239：818-825, 2004

12）Adam R, Delvart V, Pascal G, et al：Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy：a model to predict long-term survival. Ann Surg 240：644-657, 2004

13）Adam R, Pascal G, Castaing D, et al：Tumor progression while on chemotherapy：a contraindication to liver resection for multiple colorectal metastases?. Ann Surg 240：1052-1061, 2004

14）Jaeck D, Oussoultzoglou E, Rosso E, et al：A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 240：1037-1049, 2004

15）Tanaka K, Shimada H, Matsuo K, et al：Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery 136：650-659, 2004

16）Ambiru S, Miyazaki M, Ito H, et al：Adjuvant regional chemotherapy after hepatic resection for colorectal metastases. Br J Surg 86：1025-1031, 1999

17）Kemeny N, Huang Y, Cohen AM, et al：Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 341：2039-2048, 1999

18）Elias D, Ouellet JF, Bellon N, et al：Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg 90：567-574, 2003

19）Yoshidome H, Ito H, Kimura F, et al：Surgical treatment for extrahepatic recurrence after hepatectomy for colorectal metastases. Hepatogastroenterology 51：1805-1809, 2004

20）Ambiru S, Miyazaki M, Ito H, et al：Benefits and limits of hepatic resection for gastric metastases. Am J Surg 181：279-283, 2001