结直肠癌肝转移的微创治疗策略

结直肠癌是世界范围内常见的恶性肿瘤，也是肿瘤导致死亡的重要原因。肝脏是结直肠癌最常见的转移部位，约20%的患者伴有同时性肝转移，另20%患者在疾病的发展中也出现肝转移。结直肠癌肝转移（CRLM）是目前结直肠癌治疗的重点与难点，也是影响患者预后的重要因素。手术切除仍然是患者长期生存甚至治愈的最佳治疗选择，其中微创切除更是兼具微创的优势与根治的效果，长期的肿瘤学疗效也与开放手术相当。但受限于肿瘤大小、位置分布等解剖因素、患者的肝脏功能以及一般状态等因素，只有少数患者在初诊时适合手术切除。其他微创治疗策略包括消融治疗、立体定向放射治疗、介入治疗等，这些技术的发展为不可手术切除的患者提供了新的治疗机会，同时也提高了单纯系统治疗的生存率。消融治疗对于选择性的患者兼具有微创与类似手术的根治性效果，对于深部肿瘤也更具优势。立体定向放射治疗是不适合手术切除或消融困难或复发病灶的重要替代选择。Y⁹⁰选择性体内放射治疗更是兼具肿瘤控制与增大余肝的双重作用，在转化治疗时代其地位也不断上升。随着微创理念的深化与技术的进步，CRLM的微创治疗取得一定进展，但仍面临诸多挑战，如在精准、个体化与转化治疗时代微创治疗策略如何合理地联合或序贯使用等。在选择微创治疗策略时，应该根据多学科团队的指导进行个体化评估和综合治疗，尽可能实现R₀切除或无疾病证据状态，从而最大程度地提高患者的长期生存率。本文就近年来CRLM的微创治疗策略进行综述，以期为临床治疗的选择提供参考。

Minimally invasive treatment strategies for colorectal cancer liver metastases

Colorectal cancer is a common malignant tumor worldwide and a significant cause of cancer-related deaths. The liver is the most frequent site of metastasis for colorectal cancer, about 20% of patients have simultaneous liver metastasis, and an additional 20% develop liver metastasis during the progression of the disease. Colorectal cancer liver metastasis (CRLM) is currently a focal and challenging aspect of colorectal cancer treatment, and also an essential factor affecting the prognosis of patients. Surgical resection remains the optimal treatment choice for long-term survival and even cure. Minimally invasive resection, in particular, combines the advantages of minimally invasive procedures with curative effects, showing equivalent long-term oncological efficacy to open surgery. However, limited by tumor size, location distribution and other anatomical factors, liver function, and general status of patients, only a few patients are suitable for surgical resection at the time of initial diagnosis. Other minimally invasive treatment strategies include ablation therapy, stereotactic body radiation therapy, interventional therapy, etc. The development of these technologies provides new therapeutic opportunities for unresectable patients and also improves the survival rates of systemic treatment alone. Ablation therapy, for selected patients, combines the minimally invasive nature with radical effect similar to surgery, and is also more advantageous for deep-seated tumors. Stereotactic body radiation therapy is an important alternative for difficult or recurrent lesions that are unsuitable for surgical resection or ablation. Furthermore, Y⁹⁰ selective internal radiation therapy has a dual effect of tumor control and enlarging the remnant liver. Its significance is continuously growing in the era of transformative treatment. With the deepening of minimally invasive concepts and technological advancements, there has been some progress in the minimally invasive treatment of CRLM. However, it still faces numerous challenges, such as how to rationally combine or sequentially use minimally invasive treatment strategies in the era of precision, personalized, and transformative therapy. When selecting minimally invasive treatment strategies, individualized evaluation and comprehensive treatment should be carried out according to the guidance of the multidisciplinary team, with the goal to achieve R₀ resection or no-evidence-of-disease status as much as possible, thereby maximizing the long-term survival rates for patients. This article provides a review of recent advances in minimally invasive treatment strategies for CRLM, so as to serve as a reference for clinical practice.