简介：Livermetastasessynchronouslyormetachronouslyoccurinapproximately50%ofcolorectalcancerpatients.Multimodalitycomprehensivetreatmentisthebesttherapeuticstrategyforthesepatients.However,theoptimalpatternofmultimodalitytherapyisstillcontroversial,anditraisesseveralsignificantconcerns.Liverresectionisthemostimportanttreatmentforcolorectallivermetastases.ThedefinitionofresectabilityhasshiftedtofocusonthecompletionofR0resectionandnormalliverfunctionmaintenance.Theroleofneoadjuvantandadjuvantchemotherapystillneedstobeclarified.Themanagementofeitherprogressionorcompleteremissionduringneoadjuvantchemotherapyischallenging.Theoptimalsequencingofsurgeryandchemotherapyinsynchronouscolorectallivermetastasespatientsisstillunclear.Conversionalchemotherapy,portalveinembolization,two-stageresection,andtumorablationareeffectiveapproachestoimproveresectabilityforinitiallyunresectablepatients.Severaltechnicalissuesandconcernsrelatedtothesemethodsneedtobefurtherexplored.Forpatientswithdefinitelyunresectableliverdisease,thenecessityofresectingtheprimarytumorisstilldebatable,andevaluatingandpredictingtheefficacyoftargetedtherapydeservefurtherinvestigation.Thisreviewdiscussesdifferentpatternsandimportantconcernsofmultidisciplinarytreatmentofcolorectallivermetastases.

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简介：Neuroendocrinetumors(NET)areaheterogeneousgroupofcancers,withindolentbehavior.Themostcommonprimaryoriginisthegastro-intestinaltractbutcanalsoappearinthelungs,kidneys,adrenals,ovariesandotherorgans.Ingeneral,NETisusuallydiscoveredinthemetastaticphase(40%-80%).Theliveristhemostcommonorganinvolvedwhenmetastasesoccur(40%-93%),followedbybone(12%-20%)andlung(8%-10%).Anumberofdifferenttherapeuticoptionsareavailableforthetreatmentofhepaticmetastasesincludingsurgicalresection,transplantation,ablation,trans-arterialchemoembolization,chemotherapyandsomatostatinanalogues.Recently,moleculartargetedtherapieshavebeenused,usuallyincombinationwithothertreatmentoptions,toimproveoutcomesinpatientswithmetastases.ThisarticleemphasizesontheroleofsurgeryinthetreatmentoflivermetastasesfromNET.

简介：Splenicmetastasisisgenerallynotacommonclinicalevent.However,metastasistothespleenfromadrenalpheochromocytomaisextremelyrareandhasnotbeenreportedinliterature.Thisreportpresentsacaseofa58year-oldmalepatientwhodevelopedspleen-onlymetastasesinJuly2007.ThepatienthadaprevioushistoryofleftepinephroectomyforadrenalpheochromocytomainJanuary2003.Abdominalcomputedtomographydemonstratedmultipleenhancinglesionssuggestiveofmetastases;thussplenectomywasperformed.Pathologicalexaminationsconfirmedthediagnosisofsplenicmetastasesfrompheochromocytoma.Thepatientwasalivewithoutrecurrence48monthsaftersplenectomy.Thisstudyisthefirstreportonsplenicmetastasisfrompreviousadrenalpheochromocytoma,andlong-termsurvivalwasachievedbysplenectomy.Ahistoryofmalignancyindicatesahighindexofsuspicionforsplenicmetastasis,andlong-termsurvivalcanbeachievedbysplenectomyforspleen-onlymetastasis.

简介：A64-year-oldmanwasadmittedtotheSunYat-SenUniversityCancerCenterwithchiefcomplaintsofrecurrentabdominalpainanddiarrheaforabout3yearsandwithahistoryofsurgicalrepairforintestinalperforationowingtostressulcer.Positronemissiontomography(PET)/computedtomography(CT)demonstratedaprimarytumoronthepancreatictailwithmultifocallivermetastases.Pathologicalandimmunohistochemistrystainingrevealedthelesiontobeapancreaticneuroendocrinetumor(pNET).AccordingtothelatestWorldHealthOrganization(WHO,2013)classification,thetumorwasclassifiedasstageIVfunctionalG1pNET.Afterreferraltothemultidisciplinarytreatmentboard(MDT),thepatientwasstartedonperiodicdoseofomeprazole,somatostatinanaloguesandInterferonα(IFNα)andhadscanningfollow-ups.Basedupontheimagingresults,CT-guidedradioactiveiodine-125(125I)seedsimplantationtherapy,radiofrequencyablationtherapy(RFA)ormicrowaveablationtechniquewerechosenforthetreatmentoftheprimarytumor.Transarterialchemoembolization(TACE),RFAandmicrowaveablationtechniquesweredecideduponforlivermetastases.Thepatientshowedbeneficialresponsetothetreatmentwithclinicallymanageablelow-gradesideeffectsandattainedpartialremission(RECISTcriteria)withagoodqualityoflife.

简介：Advancedgastriccancer(GC)hasbeenrecognizedaslethaldiseasewhenperitonealmetastases(PM)occurred.ThereisnostandardtreatmentforadvancedGCwithPM.Until1980s,thetherapeuticarenaforthesepatientshadremainedstagnant,withnotherapeuticapproachhavingshownasurvivalgaininGCwithPM.However,cytoreductivesurgery(CRS)withperitonectomyproceduresandintraperitonealchemotherapy(IPC)promisingnewcombinedtherapeuticapproachtoachievediseasecontrolforGCwithPM.TherecentpublicationschangedtheGCwithPMtreatmentlandscapebyprovidinganevidencethatCRSandIPCledtoprolongationinoverallsurvival(OS).ThisreviewwillprovideanoverviewoftheevolvingroleofCRSandIPCinthemanagementofadvancedGCwithPMinthecurrentera.

简介：AbstractPancreatic ductal adenocarcinoma (PDAC) represents one of the most aggressive malignancies, and the majority of patients with PDAC present with metastatic disease, mainly in the liver, at the time of diagnosis. Surgical resection is the only treatment that can offer prolonged survival and possible cure. However, the indications for surgery for patients with PDAC metastases remain extremely limited to highly selected patients with localized disease, and metastatic disease is generally regarded as a contraindication to surgery. Recently, however, the advent of more effective chemotherapy has changed the treatment strategy for metastatic PDAC. In fact, cases in which resection of synchronous or metachronous PDAC liver metastases lead to prolonged survival in highly selected patients have been reported. In this review, we provide current data regarding survival outcomes after surgery, and discuss the role of surgical resection and selection criteria for patients with PDAC liver metastases in the modern era.

简介：ＩＭＭＵＮＯＣＹＴＯＣＨＥＭＩＣＡＬＣＨＡＲＡＣＴＥＲＩＺＡＴＩＯＮＯＦＣＤ４４ＭＯＬＥＣＵＬＥＳＥＸＰＲＥＳＳＥＤＩＮＨＵＭＡＮＢＲＡＩＮＭＥＴＡＳＴＡＳＥＳＬｉＨｏｎｇ李宏；ＬｉｕＪｉａ刘佳；ＭａｒｔｉｎＨｏｆｍａｎｎ；Ｍａｒｉａｅ－Ｆｒａｎｃｅ...

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简介：Colorectalcancerhepaticmetastasesrepresentthefinalstageofamulti-stepbiologicalprocess.Thisprocessstartswithaseriesofmutationsincolonicepithelialcells,continueswiththeirdetachmentfromthelargeintestine,disseminationthroughthebloodand/orlymphaticcirculation,attachmenttothehepaticsinusoidsandinteractionswiththesinusoidalcells,suchassinusoidalendothelialcells,Kupffercells,stellatecellsandpitcells.Themetastaticsequenceterminateswithcolorectalcancercellinvasion,adaptationandcolonisationofthehepaticparenchyma.Alltheseevents,termedthecolorectalcancerinvasion-metastasiscascade,includemultiplemolecularpathways,intercellularinteractionsandexpressionofaplethoraofchemokinesandgrowthfactors,andadhesionmolecules,suchastheselectins,theintegrinsorthecadherins,aswellasenzymesincludingmatrixmetalloproteinases.Thisreviewaimstopresentrecentadvancesthatprovideinsightsintothesecell-biologicaleventsandemphasizesthosethatmaybeamenabletotherapeutictargeting.

简介：BetweenJanuary1985andJuly1987,1,622cancerpatientswereevaluatedtooutlinethepossibleapplicationsandlimitsofvariousinvestigativetechniquesforevaluatingmetastases.Seventy-threecaseswithsuperficialmetastasesofthedermal-hypodermal(59)layers,ofthemuscles(11)andofothertargetorgans(3)wereincludedinthestudy.Althoughnon-glandularsuperficialmetastasesarearelativelyrareoccurrence,diagnosticimagingtechniquesareindicatedforevaluatingtheirextentandanatomicalconnections.Secondaryneoplasmswerestudiedusingtheimagingtechniquesofsono-graphy,computedtomographyandxeroradiography.Thediagnosticreliabilityofthesethreetechniqueswasevaluated,takingintoaccounttheirabilitytodeterminetheextentofmetastasesandofassessingmalignancy.Sonographyisconsideredasasatisfactoryscreeningtechnique,butCTisanevenbettertoolforevaluatingtheextentandanatomicalconnectionsofsuchlesions.Xeroradiographyhasbeenmadeobsoleteb

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简介：Objective:Toassesstheimpactofpastlivermetastasesonthesurvivaldurationofpatientswhoareundergoingsurgeryforlungmetastases.Methods:Weconductedareviewofliteraturepublishedfrom2007to2014.ThestudieswereidentifiedbysearchingPubMed,MEDLINE,andEmbaseandweresupplementedbyamanualsearchofthereferenceslistedbytheretrievedstudies.Thefollowingsearchtermswereused:lungmetastasectomy,pulmonarymetastasectomy,lungmetastases,andlungmetastasis.Weselectedretrospectiveandprospectivestudiespublishedfrom2007to2014onpatientswithlungmetastasesfromcolorectalcancerandwereundergoingsurgerywithcurativeintent.Weexcludedreviews,studiesthatfocusedonsurgicaltechniques,patientswhoweretreatednon-surgically,analysesofspecificsubgroupsofpatients,andthosethatdidnotreportfollow-upofthepatientsundergoingsurgery.Results:Weidentified28papersthatassessedsurvivalafterlungmetastases,21ofwhichweremostlyretrospectivestudiesthatidentifiedpreviouslivermetastasestoexploretheirimpactonpatientsurvival.Inmorethanhalfofthepapersanalyzed(63.2%),patientswithahistoryofresectedlivermetastaseshadalowersurvivalratethanthosewhodidnothavesuchahistory,andthedifferencewasstatisticallysignificantineightofthesestudies.However,datawerepresenteddifferently,andauthorsreportedmeansurvivaltime,survivalrates,orhazardratios.Conclusions:Ahistoryoflivermetastasesseemstobeanegativeprognosticfactor,buttheindividualdataneedtoundergoameta-analysis.

简介：瞄准：与颜色在病人在肝切除术期间发现秘密转移表面的癌症肝转移(CRCLM)，提高对比的intraoperativeultrasonography(CE-IOUS)用一个新微水泡代理人被执行，sonazoid，它在Kupffer房间基于它的累积提供一幅实质特定的对比图象。方法：有CRCLM的八个病人在肝切除术前用sonazoid经历了CE-IOUS。肝在迟了的Kupffer阶段成像期间被调查，它是sonazoid的一个珍贵特征。结果：用sonazoid的CE-IOUS提供了早脉管阶段并且为10min的正弦曲线阶段图象在sonazoid的注射以后由迟了的Kupffer阶段图象列在后面直到30min。IOUS没在8个病人提供变形损害的新调查结果。在sonazoid的迟了的Kupffer阶段图象期间，然而，变形损害最新在8个病人中的二个被发现。这些最新检测的损害被作为转移诊断的另外的肝切除术和组织病理学说的联盟者移开。结论：用sonazoid的CE-IOUS能允许外科医生与足够的时间调查整个肝并且intraoperatively发现新转移。