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Современные подходы к хирургическому лечению больных колоректальным раком с метастазами в печени

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При метастазах колоректального рака в печени методом выбора является резекция органа, позволяющая увеличить пятилетнюю выживаемость больных до 40-58%. В последние годы пересматривают критерии резектабельности, кандидатами для хирургического лечения считают больных, у которых возможно удаление всех метастазов с отрицательными границами резекции и адекватным объемом остающейся паренхимы печени. В настоящее время резектабельность определяют в большей мере по минимально допустимому объему нормально функционирующей печеночной паренхимы. В рамках новой парадигмы увеличивается число больных с потенциально резектабельным онкологическим процессом. Однако общепринятых понятий и критериев резектабельности не существует, что затрудняет выбор лечебной тактики и напрямую влияет на выживаемость больных. Поиск литературы для обзора осуществляли в системах PubMed, Cochrane Library, Google Scholar и еLibrary. Включали публикации, характеризующие современные возможности хирургии печени, направленные на увеличение резектабельности и улучшение онкологических результатов у больных колоректальным раком с метастазами в печени.

Ключевые слова:
колоректальный рак, печень, метастазы, резектабельность, резекция, паренхимосберегающая хирургия, colorectal cancer, liver, metastases, resectability, resection, parenchyma-sparing surgery

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Modern approaches to surgical treatment of patients with colorectal cancer liver metastases

Hepatic resection has become the treatment of choice for metastatic colorectal cancer, and this treatment technique increases the five-year survival of cancer patients up to 40-58%. More recently, the criteria for resectability have been revised and expanded to include any patient in whom all metastatic deposits can be removed with a negative surgical margin and with sufficient residual liver parenchyma. Currently, resectability is determined mostly by the minimum functional liver remnant volume. Under this new paradigm, the number of patients with potentially resectable oncological process can be increased. However, there are no widely accepted concepts and criteria for resectability, which further complicates the choice of treatment methods and directly affects the patients’ survival. The literature search for this review was performed using PubMed, Cochrane Library, Google Scholar, and eLibrary systems. We included publications that characterized the modern possibilities of liver surgery aimed at increasing resectability and improving cancer outcomes in patients with colorectal cancer liver metastases.

Keywords:
колоректальный рак, печень, метастазы, резектабельность, резекция, паренхимосберегающая хирургия, colorectal cancer, liver, metastases, resectability, resection, parenchyma-sparing surgery