INTESTINE Vol.7 No.3(4-1)

特集名 大腸癌肝転移の画像診断と治療
題名 治療 (1) 治療法の選択
発刊年月 2003年 05月
著者 上野 秀樹 防衛医科大学校外科学第一講座
著者 橋口 陽二郎 防衛医科大学校外科学第一講座
著者 望月 英隆 防衛医科大学校外科学第一講座
【 要旨 】 要旨はありません。
Theme Recent advances in the diagnostic imaging and the treatment of liver metastates from colorectal cancer
Title Strategies for colorectal liver metastases
Author Hideki Ueno Department of Surgery I, National Defense Medical College
Author Yojiro Hashiguchi Department of Surgery I, National Defense Medical College
Author Hidetaka Mochizuki Department of Surgery I, National Defense Medical College
[ Summary ] Liver resection is at present the treatment of choice for patients with colorectal metastases, with 25-40% of resected patients being alive five years after treatment. Surgery used to be feasible in under 30% of patients with colorectal liver metastases, however, surgical indications have recently tended to be widened in Japan. Even patients with four or more metastatic liver deposits, or those with extrahepatic disease, often undergo liver resection. In such situations, the establishment of a risk scoring system, using independent predictors of poor outcome, is essential in making surgical treatment be an efficient strategy by excluding patients with short term recurrence after liver resection from those who are candidates for surgery. For patients with unresectable diseases, chemotherapy (systemic chemotherapy for patients with extrahepatic disease and intra-arterial chemotherapy for patients with life-threatening liver diseases), local ablation techniques [microwave coagulation technique (MCT) or radio-frequency ablation (RFA)], and, liver transplantation (in western countries), have been chosen, though long term survival cannot be obtained through these strategies. Gene therapy is expected to be a novel strategy for such patients and several phase I and II clinical studies have been performed since the late 1990s, primarily in the United States.