臨床外科79巻9号

2024年09月発行

特集 徹底解説　大腸癌治療ガイドライン2024 詳説

肝転移に対する治療—大腸癌肝転移に対する2024年版治療ガイドライン上の変更点

著者： 阪本良弘¹

所属機関： ¹杏林大学医学部付属病院肝胆膵外科

ページ範囲：P.1040 - P.1044

【ポイント】
◆『大腸癌治療ガイドライン—医師用2024年版』での大腸癌肝転移に対する治療の改訂点は，①定位放射線治療の付記，②画像上消失した転移巣における術前EOB-MRIと術中造影超音波の活用の推奨，③熱凝固療法の弱い推奨，④腹腔鏡下肝切除の弱い推奨，⑤ロボット支援肝切除の付記，⑥非系統的切除の推奨である．
◆大腸癌肝転移の治療は集学的治療の枠組みの中で，多様性が増していると考えられる．

参考文献

1）大腸癌研究会（編）：大腸癌治療ガイドライン—2024年度版．金原出版，2024

2）大腸癌研究会（編）：大腸癌治療ガイドライン—2022年度版．金原出版，2022

3）Flickinger JC, Kondziolka D, Lunsford LD, et al：A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28：797-802, 1994

4）Kokudo N, Tada K, Seki M, et al：Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma. Am J Surg 181：153-159, 2001

5）Mise Y, Aloia TA, Brudvik KW, et al：Parenchymal-sparing Hepatectomy in Colorectal Liver Metastasis Improves Salvageability and Survival. Ann Surg 263：146-152, 2016

6）Oba A, Mise Y, Ito H, et al：Clinical implications of disappearing colorectal liver metastases have changed in the era of hepatocyte-specific MRI and contrast-enhanced intraoperative ultrasonography. HPB（Oxford）20：708-714, 2018

7）Arita J, Ono Y, Takahashi M, et al：Usefulness of contrast-enhanced intraoperative ultrasound in identifying disappearing liver metastases from colorectal carcinoma after chemotherapy. Ann Surg Oncol 21 Suppl 3：S390-S397, 2014

8）Tani K, Shindoh J, Akamatsu N, et al：Management of disappearing lesions after chemotherapy for colorectal liver metastases：Relation between detectability and residual tumors. J Surg Oncol 117：191-197, 2018

9）Robles-Campos R, Lopez-Lopez V, Brusadin R, et al：Open versus minimally invasive liver surgery for colorectal liver metastases（LapOpHuva）：a prospective randomized controlled trial. Surg Endosc 33：3926-3936, 2019

10）Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, et al：Laparoscopic Versus Open Resection for Colorectal Liver Metastases：The OSLO-COMET Randomized Controlled Trial. Ann Surg 267：199-207, 2018

11）Fretland ÅA, Dagenborg VJ, Waaler Bjørnelv GM, et al：Quality of life from a randomized trial of laparoscopic or open liver resection for colorectal liver metastases. Br J Surg 106：1372-1380, 2019

12）Aghayan DL, Kazaryan AM, Dagenborg VJ, et al：Long-Term Oncologic Outcomes After Laparoscopic Versus Open Resection for Colorectal Liver Metastases：A Randomized Trial. Ann Intern Med 174：175-182, 2021

13）Ruers T, Van Coevorden F, Punt CJ, et al：Local Treatment of Unresectable Colorectal Liver Metastases：Results of a Randomized Phase II Trial. J Natl Cancer Inst 109：djx015, 2017

14）Imai K, Allard MA, Castro Benitez C, et al：Long-term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases. Br J Surg 104：570-579, 2017

15）van Amerongen MJ, van der Stok EP, Fütterer JJ, et al：Short term and long term results of patients with colorectal liver metastases undergoing surgery with or without radiofrequency ablation. Eur J Surg Oncol 42：523-530, 2016

16）Karanicolas PJ, Jarnagin WR, Gonen M, et al：Long-term outcomes following tumor ablation for treatment of bilateral colorectal liver metastases. JAMA Surg 148：597-601, 2013

17）Liu M, Wang K, Wang Y, et al：Short- and long-term outcomes of hepatectomy combined with intraoperative radiofrequency ablation for patients with multiple primarily unresectable colorectal liver metastases：a propensity matching analysis. HPB（Oxford）23：1586-1594, 2021