结直肠癌肝转移诊断和综合治疗指南（2025版）

指南 消化内科 · 2025 · 中国普通外科杂志

扫码或点击下方链接阅读下载全文

doi: 10.7659/j.issn.1005-6947.250402 ## 结直肠癌肝转移诊断和综合治疗指南（2025版） 中国医师协会外科医师分会；中华医学会外科分会胃肠外科学组；中华医学会外科分会结直肠外科学组；中国抗癌协会大肠癌专业委员会；中国医师协会结直肠肿瘤专业委员会；中国临床肿瘤学会结直肠癌专家委员会；中国医师协会外科医师分会结直肠外科医师委员会；中国医师协会肛肠医师分会肿瘤转移委员会；中华医学会肿瘤学分会结直肠肿瘤学组；中国医疗保健国际交流促进会转移肿瘤治疗学分会；中国医疗保健国际交流促进会结直肠病分会 摘　要 为进一步规范和提升我国结直肠癌肝转移的诊疗水平，《结直肠癌肝转移诊断和综合治疗指南（2025版）》在以往版本基础上，结合近年来国内外研究进展和临床经验，进行了系统更新。新版指南在优化诊断流程、加强多学科团队协作的基础上，全面升级了治疗策略，涵盖可达到无疾病证据状态（NED）患者的外科手术、辅助与新辅助治疗，及无法达到NED状态患者的综合治疗方案；同时拓展了基因检测内容，引入多种局部毁损新技术，强调规范随访与长期管理，力求实现治疗个体化、精准化，最终改善患者预后。指南旨在为全国医疗机构在结直肠癌肝转移的临床实践中提供循证、实用的参考依据。 关键词 结直肠肿瘤；肿瘤转移；诊疗准则 中图分类号： R735.3 Chinese guidelines for the diagnosis and comprehensive treatment of colorectal liver metastases (2025 edition) Chinese Society of Surgeons, Chinese Medical Doctor Association; Gastrointestinal Surgery Group, Chinese Society of Surgery, Chinese Medical Association; Colorectal Surgery Group, Chinese Society of Surgery, Chinese Medical Association; Colorectal Cancer Committee, Chinese Anti-Cancer Association; Colorectal Oncology Committee, Chinese Medical Doctor Association; Expert Committee on Colorectal Cancer, Chinese Society of Clinical Oncology; Colorectal Surgery Committee, Chinese Society of Surgeons, Chinese Medical Doctor Association; Tumor Metastasis Committee, Coloproctology Society, Chinese Medical Doctor Association; Colorectal Oncology Group, Chinese Society of Oncology, Chinese Medical Association; Division of Metastatic Tumor Therapy, China International Exchange and Promotive Association for Medical and Health Care; Division of Colorectal Diseases, China International Exchange and Promotive Association for Medical and Health Care Abstract　To further standardize and improve the management of colorectal liver metastases (CRLM) in China, the Chinese guidelines for the diagnosis and comprehensive treatment of colorectal cancer liver metastases (2025 edition) have been systematically updated based on previous versions and the latest international and domestic evidence. The updated guideline refines diagnostic pathways, strengthens multidisciplinary team collaboration, and comprehensively upgrades therapeutic strategies-including surgical resection, neoadjuvant and adjuvant treatments for patients eligible for no evidence of disease (NED) status, and systemic therapy for those who are not. It also expands the scope of genetic testing, incorporates innovative local ablative therapies, and emphasizes standardized follow-up and long-term management. The guideline aims to promote individualized and precision-based treatment, ultimately improving clinical outcomes and patient survival. It serves as a practical, evidence-based reference for healthcare providers managing CRLM across China. Key words　 Colorectal Neoplasms; Neoplasm Metastasis; Practice Guideline CLC number: R735.3 肝脏是结直肠癌血行转移最主要的靶器官，结直肠癌肝转移（colorectal cancer liver metastases）是结直肠癌治疗的重点和难点之一[1-2]。约有15%~25%结直肠癌患者在确诊时即合并有肝转移，而另15%~25%的患者在结直肠癌原发灶根治术后发生肝转移，其中绝大多数（80%~90%）的肝转移灶初始无法获得根治性切除[3]。肝转移也是结直肠癌患者最主要的死亡原因[4-5]，未经治疗的肝转移患者的中位生存期仅6.9个月，无法切除患者的5年生存率低于5%[6]，而肝转移灶能完全切除[或可以达到无疾病证据（no evidence of disease，NED）状态]患者的中位生存期达35~60个月，5年总体生存率可达40%~57%[7-11]。研究表明，有一部分最初肝转移灶无法根除的患者经治疗后可以转化为可切除或达到NED状态。因此，通过多学科团队（multidisciplinary team，MDT）对结直肠癌肝转移患者进行全面地评估，个性化地制定治疗目标，开展相应的综合治疗，以预防结直肠癌肝转移的发生、提高肝转移灶手术切除率和5年生存率[12-13]。 为了提高我国结直肠癌肝转移的诊断和综合治疗水平，受卫生部临床重点学科项目资助（2008—2010年），中华医学会外科分会胃肠外科学组和结直肠外科学组、中国抗癌协会大肠癌专业委员会自2008年起联合编写了《结直肠癌肝转移诊断和综合治疗指南》（草案），以指导我国结直肠癌肝转移的诊断和治疗，并于2010年、2013年先后进行了两次修订。2016年、2018年、2020年、2023年联合中国医师协会外科医师分会结直肠外科医师委员会、中国医疗保健国际交流促进会转移肿瘤治疗学分会和结直肠病分会、中国临床肿瘤学会结直肠癌专家委员会、中国医师协会结直肠肿瘤专业委员会、中国医师协会肛肠医师分会肿瘤转移委员会、中华医学会肿瘤学分会结直肠肿瘤学组、中国医师协会外科医师分会等多次共同修订了《指南》。2025年再次共同总结国内外先进经验和最新进展修订本《指南》。（本文中出现的推荐级别、循证医学证据分类的界定，详见附录1；本《指南》对结直肠癌肝转移的诊断、预防、外科手术和其他综合治疗提出的建议，请各地医院根据实际情况予以应用，诊疗流程详见附录2）。 1　结直肠癌肝转移的诊断与随访 1.1 结直肠癌肝转移的定义 按照国际共识，同时性肝转移（synchronous liver metastases）是指结直肠癌确诊前或确诊时发现的肝转移；而结直肠癌根治术后发生的肝转移称为异时性肝转移（metachronous liver metastases）[14]。本指南为便于诊疗策略的制定，将按照“结直肠癌确诊时合并肝转移”和“结直肠癌根治术后发生肝转移”两方面阐述。 1.2 结直肠癌确诊时肝转移的诊断常规 对已确诊结直肠癌的患者，除血清CEA、CA19-9等肿瘤标志物检查、病理分期评估外，应常规进行肝脏超声和腹部CT增强等影像检查筛查及诊断肝脏转移瘤。对于超声或CT影像高度怀疑但不能确诊的患者可加行血清甲胎蛋白、肝脏超声造影和肝脏MRI增强检查[15-16]（1a类证据，A级推荐），肝脏细胞特异性造影剂增强MRI检查对于发现1 mm[123-124]。⑵ 如是局限于左半或右半肝的较大肝转移灶且无肝硬化者，可行规则的半肝切除。⑶ 肝转移手术时采用术中超声或超声造影检查，有助于发现术前影像学检查未能诊断的肝转移病灶。肝脏微创手术切除比例逐渐增多，显示出更好的短期结局。而且，使用人工智能影像进行肝脏手术精准规划应用也日益增多。⑷ 应用门静脉选择性的栓塞（PVE）或结扎（PVL）可以使肝转移灶切除术后预期剩余肝脏代偿性增大，增加手术切除的可能。此方法被用于预计手术切除后剩余肝脏体积不足30%的肝转移患者。对于那些剩余肝脏体积在30%~40%，并且接受了强烈化疗而有肝实质损伤的患者，同样也可从中得益[125]（4类证据，C级推荐）。联合肝脏离断和门静脉结扎的二步肝切除术（associating liver partition and portal vein ligation for staged hepatectomy，ALPPS）可使残留肝脏的体积在较短时间内明显增大而获得更多Ⅱ期肝切除的机会，但此手术复杂，并发症发生率及死亡率均高于传统肝切除，故建议在严格选择的患者中由经验丰富的肝脏外科医师实施手术[126]。放射性同时门静脉和肝静脉栓塞（radiological simultaneous portohepatic vein embolization，RASPE），又称肝静脉剥夺术[127]（liver venous deprivation，LVD），对比单纯门静脉栓塞和联合肝脏离断和ALPPS[128]，不仅可使残余肝迅速增生，而且并发症发生率和死亡率低于ALPPS[129]，具有操作简捷、创伤小、安全等优点，但仍需更多研究进一步评价，临床研究可关注。 放射性微球选择性内放射治疗（selective internal radiotherapy，SIRT）是兼具控制肿瘤和增大残余肝体积的临床治疗手段。研究综述显示，钇-90 SIRT用于单侧肝叶SIRT后1~9个月，对侧肝叶平均增大29%~57%，肿瘤控制良好，有利于随后的肝转移切除手术[130-131]。⑸ 对于经过肝切除、局部消融治疗、系统性化疗、介入治疗、分子靶向治疗、免疫检查点抑制剂治疗等多种方法的联合或序贯治疗仍无法达到NED但仍局限于肝转移的患者，如对全身化疗有反应，肝移植联合全身治疗，显著提高总体生存率，可酌情谨慎选择[132-134]。 4.1.5 肝转移灶切除术后复发和肝外转移灶的切除　在全身状况和肝脏条件允许的情况下，对于可切除的肝转移灶术后的复发病灶，经MDT讨论后，可再次选择手术切除或其他局部治疗，文献报道显示其手术并发症发生率和死亡率并不高于第1次肝转移灶的切除，而且可获得相同的术后生存率[102,135]（3b类证据，B级推荐）。同样，在患者全身状况允许时，如果肺[136]和腹腔[137]等的肝外转移病灶可完全切除，也应进行同步或分阶段切除（3b类证据，B级推荐）。 4.2 可以达到NED状态的肿瘤局部毁损治疗 除了手术切除肝转移灶外，有些治疗手段（如射频消融、微波消融和放射治疗）也能使病灶发生彻底毁损，所以对于手术切除难度较大的个别肝转移灶应积极联合此类手段，以使更多的患者有机会达到NED状态，提高5年生存率[138]。 射频消融高效破坏肝转移灶肿瘤细胞，使用方便，安全性好，具有创伤小、可重复等优势[139-141]。可作为肝病灶手术切除的重要补充，达到NED状态。建议应用时选择肝转移灶最大直径3 cm的肝转移灶，SBRT疗效优于射频消融，是首选的非手术局部治疗手段[142-143]。 5　可达到NED状态结直肠癌肝转移的新辅助及辅助治疗 5.1 新辅助治疗 对可达到NED的结直肠癌肝转移患者可考虑进行新辅助治疗，主要基于以下几方面原因：⑴ 新辅助化疗提供了“窗口期”，观察有无新的无法切除的转移灶的出现，减少没有必要的手术。⑵ 新辅助治疗可增加R0手术的机会，增加术后残余肝脏的体积。⑶ 新辅助化疗可作为评价化疗方案敏感性的依据，指导术后化疗方案的选择。⑷ 新辅助化疗的疗效，可作为患者预后评估的一个指标。⑸ 新辅助化疗结合辅助化疗，可能改善接受治愈性手术患者的预后。 新辅助治疗在应用时也应关注如下情况的发生：⑴ 化疗可能会造成肝脏损伤：如与奥沙利铂治疗相关的肝窦阻塞综合征[144]；与伊立替康治疗相关的脂肪变性和脂肪性肝炎等[145]，这些损害均可能增加肝切除术后并发症的发生[146-147]。⑵ 影像学检查消失的转移灶术中仍应积极探查[148-149]，例如术中超声造影等[150]，若病灶有残存，应积极切除；若病灶消失而无法精确定位者应慎重考虑是否切除[151-152]。⑶ 转移灶进展致使无法达到NED。 5.1.1 结直肠癌确诊时合并肝转移的新辅助治疗　在原发灶无出血、梗阻症状或无穿孔时，除肝转移灶在技术上切除容易且不存在不良预后因素的患者[如临床危险评分（clinical risk score，CRS） 《结直肠癌肝转移诊断和综合治疗指南（2025版）》修订专家名单（按姓氏拼音排序） 编写组组长：樊嘉（复旦大学附属中山医院）、顾晋（北京大学肿瘤医院）、贾宝庆（中国人民解放军总医院）、李进（同济大学附属东方医院）、秦新裕（复旦大学附属中山医院）、王锡山（中国医学科学院肿瘤医院）、许剑民（复旦大学附属中山医院）、徐瑞华（中山大学肿瘤防治中心）、叶颖江（北京大学人民医院）、张苏展（浙江大学医学院附属第二医院）、张忠涛（首都医科大学附属北京友谊医院） 编写组成员：巴一（天津医科大学附属肿瘤医院）、卜建红（中华胃肠外科杂志）、蔡建辉（河北省人民医院）、蔡建强（中国医学科学院肿瘤医院）、蔡三军（复旦大学附属肿瘤医院）、曾珊（中南大学湘雅医院）、曾昭冲（复旦大学附属中山医院）、陈功（中山大学肿瘤防治中心）、陈敏（中华消化外科杂志）、陈子华（中南大学湘雅医院）、程洁敏（复旦大学附属中山医院）、程勇（重庆医科大学附属第一医院）、池畔（福建医科大学附属协和医院）、崔滨滨（哈尔滨医科大学附属肿瘤医院）、崔明（北京大学肿瘤医院）、戴朝六（中国医科大学附属盛京医院）、戴广海（中国人民解放军总医院）、戴勇（山东大学齐鲁医院）、邓艳红（中山大学附属第六医院）、丁克峰（浙江大学医学院附属第二医院）、樊嘉（复旦大学附属中山医院）、房学东（吉林大学中日联谊医院）、龚建平（华中科技大学同济医学院附属同济医院）、顾晋（北京大学肿瘤医院）、顾艳宏（江苏省人民医院）、韩卫东（浙江省肿瘤医院）、何裕隆（中山大学附属第一医院）、黄平（江苏省人民医院）、黄忠诚（湖南省人民医院）、贾宝庆（中国人民解放军总医院）、江晓晖（江苏省南通市肿瘤医院）、姜可伟（北京大学人民医院）、金晶（中国医学科学院肿瘤医院）、孔大陆（天津医科大学附属肿瘤医院）、兰平（中山大学附属第六医院）、冷建军（北京大学首钢医院）、李德川（浙江省肿瘤医院）、李海（宁夏医科大学总医院）、李进（同济大学附属东方医院）、李乐平（山东省立医院）、李胜棉（河北医科大学第四医院）、李宇红（中山大学肿瘤防治中心）、李云峰（云南省肿瘤医院）、梁后杰（中国人民解放军陆军军医大学西南医院）、林锋（海南医科大学第二附属医院）、林 建江（浙江大学医学院附属第一医院）、林俊忠（中山大学肿瘤防治中心）、林小燕（福建医科大学附属协和医院）、刘凡隆（浙江大学医学院附属第一医院）、刘海义（山西省肿瘤医院）、刘洪俊（山东省立医院）、刘天舒（复旦大学附属中山医院）、刘云鹏（中国医科大学附属第一医院）、楼征[中国人民解放军海军军医大学第一附属医院（上海长海医院）]、卢云（青岛大学附属医院）、潘宏铭（浙江大学医学院附属邵逸夫医院）、潘志忠（中山大学肿瘤防治中心）、裴海平（中南大学湘雅医院）、裴炜（中国医学科学院肿瘤医院）、彭涛（广西医科大学第一附属医院）、秦新裕（复旦大学附属中山医院）、邱萌（四川大学华西医院）、任黎（复旦大学附属中山医院）、申占龙（北京大学人民医院）、沈琳（北京大学肿瘤医院）、沈伟（上海交通大学医学院附属新华医院）、宋纯（同济大学附属东方医院）、苏向前（北京大学肿瘤医院）、孙立峰（浙江大学医学院附属第二医院）、孙益红（复旦大学附属中山医院）、陶敏（苏州大学附属第一医院）、田利国（中国实用外科杂志）、童卫东[中国人民解放军陆军军医大学陆军特色医学中心（大坪医院）]、王峰（中山大学肿瘤防治中心）、王贵英（河北医科大学第四医院）、王贵玉（哈尔滨医科大学附属第二医院）、王海江（新疆医科大学附属肿瘤医院）、王健（复旦大学附属中山医院）、王康（四川省人民医院）、王杉（北京大学人民医院）、王锡山（中国医学科学院肿瘤医院）、王新（中国人民解放军空军军医大学唐都医院）、王屹（北京大学人民医院）、王自强（四川大学华西医院）、韦烨（复旦大学附属华东医院）、吴斌（北京协和医院）、吴现瑞（中山大学孙逸仙纪念医院）、夏锋（中国人民解放 军陆军军医大学西南医院）、夏立建（山东第一医科大学第一附属医院）、谢丹（中山大学附属肿瘤防治中心）、邢宝才（北京大学肿瘤医院）、熊斌（武汉大学中南医院）、徐建明（中国人民解放军总医院）、徐农（浙江大学医学院附属第一医院）、徐瑞华（中山大学肿瘤防治中心）、徐烨（复旦大学附属肿瘤医院）、徐泽宽（江苏省人民医院）、徐忠法（山东第一医科大学第三附属医院）、许剑民（复旦大学附属中山医院）、杨润祥（云南省肿瘤医院）、杨树军（河南省肿瘤医院）、姚宏伟（首都医科大学附属北京友谊医院）、叶青海（复旦大学附属中山医院）、叶盛威（湖北省肿瘤医院）、叶颖江（北京大学人民医院）、依荷芭丽·迟（中国医学科学院肿瘤医院）、殷先利（湖南省肿瘤医院）、余佩武（中国人民解放军陆军军医大学西南医院）、余一祎（复旦大学附属中山医院）、袁瑛（浙江大学医学院附属第二医院）、张俊（上海交通大学医学院附属瑞金医院）、张克亮（湖北省肿瘤医院）、张汝一（贵州医科大学附属医院）、张苏展（浙江大学医学院附属第二医院）、张涛（同济医学院附属协和医院）、张卫[中国人民解放军海军军医大学第一附属医院（上海长海医院）]、张艳桥（哈尔滨医科大学附属肿瘤医院）、张有成（兰州大学第二医院）、张忠涛（首都医科大学附属北京友谊医院）、章真（复旦大学附属肿瘤医院）、赵青川（中国人民解放军空军军医大学西京医院）、赵任（上海交通大学医学院附属瑞金医院）、周爱萍（中国医学科学院肿瘤医院）、周波（复旦大学附属中山医院）、周俭（复旦大学附属中山医院）、周卫平（海南省肿瘤医院）、周总光（四川大学华西医院）、朱德祥（复旦大学附属中山医院）、朱陵君（江苏省人民医院） 执笔人：朱德祥（复旦大学附属中山医院）、任黎（复旦大学附属中山医院） 利益冲突：所有编者声明不存在利益冲突。 参考文献 （在框内向上滑动手指即可浏览全部参考文献） [1]Siegel RL, Wagle NS, Cercek A, et al. Colorectal cancer statistics, 2023[J]. CA Cancer J Clin, 2023, 73(3):233-254. doi:10.3322/caac.21772. [2]Eng C, Yoshino T, Ruíz-García E, et al. Colorectal cancer[J]. Lancet, 2024, 404(10449):294-310. doi:10.1016/S0140-6736(24)00360-X. [3]Vibert E, Canedo L, Adam R. Strategies to treat primary unresectable colorectal liver metastases[J]. Semin Oncol, 2005, 32(6 Suppl 8):33-39. doi:10.1053/j.seminoncol.2005.07.015. [4]Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020[J]. CA Cancer J Clinicians, 2020, 70(3):145-164. doi:10.3322/caac.21601. [5]Cohen R, Raeisi M, Chibaudel B, et al. Prognostic value of liver metastases in colorectal cancer treated by systemic therapy: an ARCAD pooled analysis[J]. Eur J Cancer, 2024, 207:114160. doi:10.1016/j.ejca.2024.114160. [6]Stewart CL, Warner S, Ito K, et al. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure?[J]. Curr Probl Surg, 2018, 55(9):330-379. doi:10.1067/j.cpsurg.2018.08.004. [7]de Jong MC, Pulitano C, Ribero D, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients[J]. Ann Surg, 2009, 250(3):440-448. doi:10.1097/SLA.0b013e3181b4539b. [8]Margonis GA, Sergentanis TN, Ntanasis-Stathopoulos I, et al. Impact of surgical margin width on recurrence and overall survival following R0 hepatic resection of colorectal metastases: a systematic review and meta-analysis[J]. Ann Surg, 2018, 267(6):1047-1055. doi:10.1097/SLA.0000000000002552. [9]Giuliante F, Ardito F, Vellone M, et al. Role of the surgeon as a variable in long-term survival after liver resection for colorectal metastases[J]. J Surg Oncol, 2009, 100(7):538-545. doi:10.1002/jso.21393. [10]Padmanabhan C, Nussbaum DP, D'Angelica M. Surgical management of colorectal cancer liver metastases[J]. Hematol Oncol Clin North Am, 2025, 39(1):1-24. doi:10.1016/j.hoc.2024.08.011. [11]Morris VK, Kennedy EB, Baxter NN, et al. Treatment of metastatic colorectal cancer: ASCO guideline[J]. J Clin Oncol, 2023, 41(3):678-700. doi:10.1200/JCO.22.01690. [12]Timmerman RD, Bizekis CS, Pass HI, et al. Local surgical, ablative, and radiation treatment of metastases[J]. CA Cancer J Clin, 2009, 59(3):145-170. doi:10.3322/caac.20013. [13]Lv Y, Feng QY, Wei Y, et al. Benefits of multi-disciplinary treatment strategy on survival of patients with colorectal cancer liver metastasis[J]. Clin Transl Med, 2020, 10(3):e121. doi:10.1002/ctm2.121. [14]Adam R, de Gramont A, Figueras J, et al. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus[J]. Cancer Treat Rev, 2015, 41(9):729-741. doi:10.1016/j.ctrv.2015.06.006. [15]Görgec B, Hansen IS, Kemmerich G, et al. MRI in addition to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): an international, multicentre, prospective, diagnostic accuracy trial[J]. Lancet Oncol, 2024, 25(1):137-146. doi:10.1016/S1470-2045(23)00572-7. [16]Ichikawa S, Goshima S. Clinical significance of liver MR imaging[J]. Magn Reson Med Sci, 2023, 22(2):157-175. doi:10.2463/mrms.rev.2022-0100. [17]Monteil J, Le Brun-Ly V, Cachin F, et al. Comparison of 18FDG-PET/CT and conventional follow-up methods in colorectal cancer: a randomised prospective study[J]. Dig Liver Dis, 2021, 53(2):231-237. doi:10.1016/j.dld.2020.10.012. [18]Coenegrachts K, De Geeter F, ter Beek L, et al. Comparison of MRI (including SS SE-EPI and SPIO-enhanced MRI) and FDG-PET/CT for the detection of colorectal liver metastases[J]. Eur Radiol, 2009, 19(2):370-379. doi:10.1007/s00330-008-1163-y. [19]Jones OM, Rees M, John TG, et al. Biopsy of resectable colorectal liver metastases causes tumour dissemination and adversely affects survival after liver resection[J]. Br J Surg, 2005, 92(9):1165-1168. doi:10.1002/bjs.4888. [20]Koshariya M, Jagad RB, Kawamoto J, et al. An update and our experience with metastatic liver disease[J]. Hepatogastroenterology, 2007, 54(80):2232-2239. [21]Komborozos VA, Skrekas GJ, Pissiotis CA. The contribution of follow-up programs in the reduction of mortality of rectal cancer recurrences[J]. Dig Surg, 2001, 18(5):403-408. doi:10.1159/000050182. [22]Tsikitis VL, Malireddy K, Green EA, et al. Postoperative surveillance recommendations for early stage colon cancer based on results from the clinical outcomes of surgical therapy trial[J]. J Clin Oncol, 2009, 27(22):3671-3676. doi:10.1200/JCO.2008.20.7050. [23]Pfister DG, Benson AB 3rd, Somerfield MR. Clinical practice. Surveillance strategies after curative treatment of colorectal cancer[J]. N Engl J Med, 2004, 350(23):2375-2382. doi:10.1056/NEJMcp010529. [24]Locker GY, Hamilton S, Harris J, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer[J]. J Clin Oncol, 2006, 24(33):5313-5327. doi:10.1200/JCO.2006.08.2644. [25]Desch CE, Benson AB 3rd, Somerfield MR, et al. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline[J]. J Clin Oncol, 2005, 23(33):8512-8519. doi:10.1200/JCO.2005.04.0063. [26]Rex DK, Kahi CJ, Levin B, et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and US Multi-Society Task Force on Colorectal Cancer[J]. CA Cancer J Clin, 2006, 56(3):160-167. doi:10.3322/canjclin.56.3.160. [27]Moreira L, Balaguer F, Lindor N, et al. Identification of Lynch syndrome among patients with colorectal cancer[J]. JAMA, 2012, 308(15):1555-1565. doi:10.1001/jama.2012.13088. [28]Umar A, Boland CR, Terdiman JP, et al. Revised Bethesda guidelines for hereditary nonpolyposis colorectal cancer (lynch syndrome) and microsatellite instability[J]. J Natl Cancer Inst, 2004, 96(4):261-268. doi:10.1093/jnci/djh034. [29]Buchanan DD, Clendenning M, Rosty C, et al. Tumor testing to identify lynch syndrome in two Australian colorectal cancer cohorts[J]. J Gastroenterol Hepatol, 2017, 32(2):427-438. doi:10.1111/jgh.13468. [30]Mulet-Margalef N, Linares J, Badia-Ramentol J, et al. Challenges and therapeutic opportunities in the dMMR/MSI-H colorectal cancer landscape[J]. Cancers (Basel), 2023, 15(4):1022. doi:10.3390/cancers15041022. [31]Chen S, Watson P, Parmigiani G. Accuracy of MSI testing in predicting germline mutations of MSH2 and MLH1: a case study in Bayesian meta-analysis of diagnostic tests without a gold standard[J]. Biostatistics, 2005, 6(3):450-464. doi:10.1093/biostatistics/kxi021. [32]Hempelmann JA, Lockwood CM, Konnick EQ, et al. Microsatellite instability in prostate cancer by PCR or next-generation sequencing[J]. J Immunother Cancer, 2018, 6(1):29. doi:10.1186/s40425-018-0341-y. [33]Stelloo E, Jansen AL, Osse EM, et al. Practical guidance for mismatch repair-deficiency testing in endometrial cancer[J]. Ann Oncol, 2017, 28(1):96-102. doi:10.1093/annonc/mdw542. [34]Modest DP, Ricard I, Heinemann V, et al. Outcome according to KRAS-, NRAS- and BRAF-mutation as well as KRAS mutation variants: pooled analysis of five randomized trials in metastatic colorectal cancer by the AIO colorectal cancer study group[J]. Ann Oncol, 2016, 27(9):1746-1753. doi:10.1093/annonc/mdw261. [35]Therkildsen C, Bergmann TK, Henrichsen-Schnack T, et al. The predictive value of KRAS, NRAS, BRAF, PIK3CA and PTEN for anti-EGFR treatment in metastatic colorectal cancer: a systematic review and meta-analysis[J]. Acta Oncol, 2014, 53(7):852-864. doi:10.3109/0284186X.2014.895036. [36]Schirripa M, Cremolini C, Loupakis F, et al. Role of NRAS mutations as prognostic and predictive markers in metastatic colorectal cancer[J]. Int J Cancer, 2015, 136(1):83-90. doi:10.1002/ijc.28955. [37]Brudvik KW, Mise Y, Chung MH, et al. RAS mutation predicts positive resection margins and narrower resection margins in patients undergoing resection of colorectal liver metastases[J]. Ann Surg Oncol, 2016, 23(8):2635-2643. doi:10.1245/s10434-016-5187-2. [38]Passot G, Chun YS, Kopetz SE, et al. Prognostic factors after resection of colorectal liver metastases following preoperative second-line chemotherapy: Impact of RAS mutations[J]. Eur J Surg Oncol, 2016, 42(9):1378-1384. doi:10.1016/j.ejso.2016.02.249. [39]Margonis GA, Buettner S, Andreatos N, et al. Anatomical resections improve disease-free survival in patients with KRAS-mutated colorectal liver metastases[J]. Ann Surg, 2017, 266(4):641-649. doi:10.1097/SLA.0000000000002367. [40]Sorich MJ, Wiese MD, Rowland A, et al. Extended RAS mutations and anti-EGFR monoclonal antibody survival benefit in metastatic colorectal cancer: a meta-analysis of randomized, controlled trials[J]. Ann Oncol, 2015, 26(1):13-21. doi:10.1093/annonc/mdu378. [41]Mao C, Yang ZY, Hu XF, et al. PIK3CA exon 20 mutations as a potential biomarker for resistance to anti-EGFR monoclonal antibodies in KRAS wild-type metastatic colorectal cancer: a systematic review and meta-analysis[J]. Ann Oncol, 2012, 23(6):1518-1525. doi:10.1093/annonc/mdr464. [42]Yaeger R, Weiss J, Pelster MS, et al. Adagrasib with or without cetuximab in colorectal cancer with mutated KRAS G12C[J]. N Engl J Med, 2023, 388(1):44-54. doi:10.1056/NEJMoa2212419. [43]Fakih MG, Salvatore L, Esaki T, et al. Sotorasib plus panitumumab in refractory colorectal cancer with mutated KRAS G12C[J]. N Engl J Med, 2023, 389(23):2125-2139. doi:10.1056/NEJMoa2308795. [44]Kopetz S, Grothey A, Yaeger R, et al. Encorafenib, binimetinib, and cetuximab in BRAF V600E-mutated colorectal cancer[J]. N Engl J Med, 2019, 381(17):1632-1643. doi:10.1056/NEJMoa1908075. [45]Van Cutsem E, Huijberts S, Grothey A, et al. Binimetinib, encorafenib, and cetuximab triplet therapy for patients with BRAF V600E-mutant metastatic colorectal cancer: safety lead-In results from the phase Ⅲ BEACON colorectal cancer study[J]. J Clin Oncol, 2019, 37(17):1460-1469. doi:10.1200/JCO.18.02459. [46]Guren TK, Thomsen M, Kure EH, et al. Cetuximab in treatment of metastatic colorectal cancer: final survival analyses and extended RAS data from the NORDIC-Ⅶ study[J]. Br. J. Cancer, 2017, 116(10):1271-1278. doi:10.1038/bjc.2017.93. [47]Sinicrope FA, Shi Q, Allegra CJ, et al. Association of DNA mismatch repair and mutations in BRAF and KRAS with survival after recurrence in stage Ⅲ colon cancers: a secondary analysis of 2 randomized clinical trials[J]. JAMA Oncol, 2017, 3(4):472-480. doi:10.1001/jamaoncol.2016.5469. [48]Pikoulis E, Margonis GA, Andreatos N, et al. Prognostic role of BRAF mutations in colorectal cancer liver metastases[J]. Anticancer Res, 2016, 36(9):4805-4811. doi:10.21873/anticanres.11040. [49]Guler I, Askan G, Klostergaard J, et al. Precision medicine for metastatic colorectal cancer: an evolving era[J]. Expert Rev Gastroenterol Hepatol, 2019, 13(10):919-931. doi:10.1080/17474124.2019.1663174. [50]Allgäuer M, Budczies J, Christopoulos P, et al. Implementing tumor mutational burden (TMB) analysis in routine diagnostics-a primer for molecular pathologists and clinicians[J]. Transl Lung Cancer Res, 2018, 7(6):703-715. doi:10.21037/tlcr.2018.08.14. [51]Ambrosini M, Rousseau B, Manca P, et al. Immune checkpoint inhibitors for POLE or POLD1 proofreading-deficient metastatic colorectal cancer[J]. Ann Oncol, 2024, 35(7):643-655. doi:10.1016/j.annonc.2024.03.009. [52]Cocco E, Scaltriti M, Drilon A. NTRK fusion-positive cancers and TRK inhibitor therapy[J]. Nat Rev Clin Oncol, 2018, 15(12):731-747. doi:10.1038/s41571-018-0113-0. [53]Kojitani Y, Takeda M. Current status of precision medicine in colorectal cancer in Japan[J]. Int J Mol Sci, 2025, 26(11):5029. doi:10.3390/ijms26115029. [54]Lin KX, Istl AC, Quan D, et al. PD-1 and PD-L1 inhibitors in cold colorectal cancer: challenges and strategies[J]. Cancer Immunol Immunother, 2023, 72(12):3875-3893. doi:10.1007/s00262-023-03520-5. [55]Artale S, Sartore-Bianchi A, Veronese SM, et al. Mutations of KRAS and BRAF in primary and matched metastatic sites of colorectal cancer[J]. J Clin Oncol, 2008, 26(25):4217-4219. doi:10.1200/JCO.2008.18.7286. [56]Etienne-Grimaldi MC, Formento JL, Francoual M, et al. K-Ras mutations and treatment outcome in colorectal cancer patients receiving exclusive fluoropyrimidine therapy[J]. Clin Cancer Res, 2008, 14(15):4830-4835. doi:10.1158/1078-0432.CCR-07-4906. [57]Knijn N, Mekenkamp LM, Klomp M, et al. KRAS mutation analysis: a comparison between primary tumours and matched liver metastases in 305 colorectal cancer patients[J]. Br J Cancer, 2011, 104(6):1020-1026. doi:10.1038/bjc.2011.26. [58]Ho HY, Chung KK, Kan CM, et al. Liquid biopsy in the clinical management of cancers[J]. Int J Mol Sci, 2024, 25(16):8594. doi:10.3390/ijms25168594. [59]Kawashima M, Yamada T, Miyasaka T, et al. Impact of minimal residual disease on early recurrence of liver metastatic colorectal cancer[J]. Cancer Sci, 2025, 116(5):1366-1374. doi:10.1111/cas.16442. [60]Parikh AR, Chee BH, Tsai J, et al. Minimal residual disease using a plasma-only circulating tumor DNA assay to predict recurrence of metastatic colorectal cancer following curative intent treatment[J]. Clin Cancer Res, 2024, 30(14):2964-2973. doi:10.1158/1078-0432.CCR-23-3660. [61]Chau I, Chan S, Cunningham D. Overview of preoperative and postoperative therapy for colorectal cancer: the European and United States perspectives[J]. Clin Colorectal Cancer, 2003, 3(1):19-33. doi:10.3816/CCC.2003.n.009. [62]Yu JH, Liao LE, Xiao BY, et al. Long-term outcomes of dMMR/MSI-H rectal cancer treated with anti-PD-1-based immunotherapy as curative-intent treatment[J]. J Natl Compr Canc Netw, 2024, 22(3):e237096. doi:10.6004/jnccn.2023.7096. [63]Gervaso L, Ciardiello D, Oliveira RA, et al. Immunotherapy in the neoadjuvant treatment of gastrointestinal tumors: is the time ripe?[J]. J Immunother Cancer, 2024, 12(5):e008027. doi:10.1136/jitc-2023-008027. [64]Zhou L, Yang XQ, Zhao GY, et al. Meta-analysis of neoadjuvant immunotherapy for non-metastatic colorectal cancer[J]. Front Immunol, 2023, 14:1044353. doi:10.3389/fimmu.2023.1044353. [65]Schrag D, Shi Q, Weiser MR, et al. Preoperative treatment of locally advanced rectal cancer[J]. N Engl J Med, 2023, 389(4):322-334. doi:10.1056/NEJMoa2303269. [66]Basch E, Dueck AC, Mitchell SA, et al. Patient-reported outcomes during and after treatment for locally advanced rectal cancer in the PROSPECT trial (alliance N1048)[J]. J Clin Oncol, 2023, 41(21):3724-3734. doi:10.1200/JCO.23.00903. [67]Yang L, Cui X, Wu F, et al. The efficacy and safety of neoadjuvant chemoradiotherapy combined with immunotherapy for locally advanced rectal cancer patients: a systematic review[J]. Front Immunol, 2024, 15:1392499. doi:10.3389/fimmu.2024.1392499. [68]Tsukada Y, Bando H, Inamori K, et al. Three-year outcomes of preoperative chemoradiotherapy plus nivolumab in microsatellite stable and microsatellite instability-high locally advanced rectal cancer[J]. Br J Cancer, 2024, 131(2):283-289. doi:10.1038/s41416-024-02730-7. [69]Gao Y, Wu A. Organ preservation in MSS rectal cancer[J]. Clin Colon Rectal Surg, 2023, 36(6):430-440. doi:10.1055/s-0043-1767710. [70]Cercek A, Roxburgh CSD, Strombom P, et al. Adoption of total neoadjuvant therapy for locally advanced rectal cancer[J]. JAMA Oncol, 2018, 4(6):e180071. doi:10.1001/jamaoncol.2018.0071. [71]Petrelli F, Trevisan F, Cabiddu M, et al. Total neoadjuvant therapy in rectal cancer: a systematic review and meta-analysis of treatment outcomes[J]. Ann Surg, 2020, 271(3):440-448. doi:10.1097/SLA.0000000000003471. [72]Turri G, Ostuzzi G, Vita G, et al. Treatment of locally advanced rectal cancer in the era of total neoadjuvant therapy: a systematic review and network meta-analysis[J]. JAMA Netw Open, 2024, 7(6):e2414702. doi:10.1001/jamanetworkopen.2024.14702. [73]Socha J, Glynne-Jones R, Bujko K. Oncological risks associated with the planned watch-and-wait strategy using total neoadjuvant treatment for rectal cancer: a narrative review[J]. Cancer Treat Rev, 2024, 129:102796. doi:10.1016/j.ctrv.2024.102796. [74]Lin W, Li C, Clement EA, et al. Surgical outcomes in total neoadjuvant therapy for rectal cancer versus standard long-course chemoradiation: a systematic review and meta-analysis of randomized controlled trials[J]. Ann Surg, 2024, 279(4):620-630. doi:10.1097/SLA.0000000000006161. [75]Xu J, Zhong Y, Niu W, et al. Preoperative hepatic and regional arterial chemotherapy in the prevention of liver metastasis after colorectal cancer surgery[J]. Ann Surg, 2007, 245(4):583-590. doi:10.1097/01.sla.0000250453.34507.d3. [76]Chang W, Wei Y, Ren L, et al. Randomized controlled trial of intraportal chemotherapy combined with adjuvant chemotherapy (mFOLFOX6) for stage Ⅱ and Ⅲ colon cancer[J]. Ann Surg, 2016, 263(3):434-439. doi:10.1097/SLA.0000000000001374. [77]Sugihara K, Ohtsu A, Shimada Y, et al. Safety analysis of FOLFOX4 treatment in colorectal cancer patients: a comparison between two Asian studies and four Western studies[J]. Clin Colorectal Cancer, 2012, 11(2):127-137. doi:10.1016/j.clcc.2011.09.001. [78]Rodríguez-Moranta F, Saló J, Arcusa A, et al. Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial[J]. J Clin Oncol, 2006, 24(3):386-393. doi:10.1200/JCO.2005.02.0826. [79]André T, Boni C, Navarro M, et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage Ⅱ or Ⅲ colon cancer in the MOSAIC trial[J]. J Clin Oncol, 2009, 27(19):3109-3116. doi:10.1200/JCO.2008.20.6771. [80]Kuebler JP, Wieand HS, O'Connell MJ, et al. Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage Ⅱ and Ⅲ colon cancer: results from NSABP C-07[J]. J Clin Oncol, 2007, 25(16):2198-2204. doi:10.1200/JCO.2006.08.2974. [81]Baxter NN, Kennedy EB, Bergsland E, et al. Adjuvant therapy for stage Ⅱ colon cancer: ASCO guideline update[J]. J Clin Oncol, 2022, 40(8):892-910. doi:10.1200/JCO.21.02538. [82]Yu TK, Bhosale PR, Crane CH, et al. Patterns of locoregional recurrence after surgery and radiotherapy or chemoradiation for rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2008, 71(4):1175-1180. doi:10.1016/j.ijrobp.2007.11.018. [83]Fennell ML, Das IP, Clauser S, et al. The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality[J]. J Natl Cancer Inst Monogr, 2010, 2010(40):72-80. doi:10.1093/jncimonographs/lgq010. [84]Nordlinger B, Vauthey JN, Poston G, et al. The timing of chemotherapy and surgery for the treatment of colorectal liver metastases[J]. Clin Colorectal Cancer, 2010, 9(4):212-218. doi:10.3816/CCC.2010.n.031. [85]Miller ED, Klamer BG, Cloyd JM, et al. Consideration of metastasis-directed therapy for patients with metastatic colorectal cancer: expert survey and systematic review[J]. Clin Colorectal Cancer, 2024, 23(2):160-173. doi:10.1016/j.clcc.2024.01.004. [86]Wright FC, De Vito C, Langer B, et al. Multidisciplinary cancer conferences: a systematic review and development of practice standards[J]. Eur J Cancer, 2007, 43(6):1002-1010. doi:10.1016/j.ejca.2007.01.025. [87]Jung SM, Hong YS, Kim TW, et al. Impact of a multidisciplinary team approach for managing advanced and recurrent colorectal cancer[J]. World J Surg, 2018, 42(7):2227-2233. doi:10.1007/s00268-017-4409-5. [88]Hernandez Dominguez O, Yilmaz S, Steele SR. Stage Ⅳ colorectal cancer management and treatment[J]. J Clin Med, 2023, 12(5):2072. doi:10.3390/jcm12052072. [89]Al Bitar S, El-Sabban M, Doughan S, et al. Molecular mechanisms targeting drug-resistance and metastasis in colorectal cancer: Updates and beyond[J]. World J Gastroenterol, 2023, 29(9):1395-1426. doi:10.3748/wjg.v29.i9.1395. [90]Karaoğlan BB, Öz DK, Araz MS, et al. Advancements in the management of synchronous colorectal liver metastases: a comprehensive review of surgical, systemic, and local treatment modalities[J]. Curr Oncol Rep, 2024, 26(7):791-803. doi:10.1007/s11912-024-01548-z. [91]Swan PJ, Welsh FS, Chandrakumaran K, et al. Long-term survival following delayed presentation and resection of colorectal liver metastases[J]. Br J Surg, 2011, 98(9):1309-1317. doi:10.1002/bjs.7527. [92]Rahbari NN, Birgin E, Bork U, et al. Anterior approach vs conventional hepatectomy for resection of colorectal liver metastasis: a randomized clinical trial[J]. JAMA Surg, 2021, 156(1):31-40. doi:10.1001/jamasurg.2020.5050. [93]Ambrosini M, Manca P, Nasca V, et al. Epidemiology, pathogenesis, biology and evolving management of MSI-H/dMMR cancers[J]. Nat Rev Clin Oncol, 2025, 22(6):385-407. doi:10.1038/s41571-025-01015-z. [94]Margalit O, Stemmer A, Chapin WJ, et al. Duration of immunotherapy in dMMR/MSI-H metastatic colorectal cancer patients[J]. Eur J Cancer, 2024, 212:114336. doi:10.1016/j.ejca.2024.114336. [95]Andre T, Elez E, Van Cutsem E, et al. Nivolumab plus ipilimumab in microsatellite-instability-high metastatic colorectal cancer[J]. N Engl J Med, 2024, 391(21):2014-2026. doi:10.1056/NEJMoa2402141. [96]Bae HW, Kim HS, Yang SY, et al. Upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer with synchronous liver metastases[J]. Eur J Surg Oncol, 2021, 47(11):2814-2820. doi:10.1016/j.ejso.2021.05.018. [97]Huang YY, Chen GW, Zhang X, et al. Pelvic radiotherapy in rectal cancer patients with synchronous potentially treatable liver metastases[J]. Cancer Rep (Hoboken), 2025, 8(1):e70122. doi:10.1002/cnr2.70122. [98]Datta J, Narayan RR, Kemeny NE, et al. Role of hepatic artery infusion chemotherapy in treatment of initially unresectable colorectal liver metastases: a review[J]. JAMA Surg, 2019, 154(8):768-776. doi:10.1001/jamasurg.2019.1694. [99]Kanani A, Veen T, Søreide K. Neoadjuvant immunotherapy in primary and metastatic colorectal cancer[J]. Br J Surg, 2021, 108(12):1417-1425. doi:10.1093/bjs/znab342. [100]Mattar RE, Al-Alem F, Simoneau E, et al. Preoperative selection of patients with colorectal cancer liver metastasis for hepatic resection[J]. World J Gastroenterol, 2016, 22(2):567-581. doi:10.3748/wjg.v22.i2.567. [101]Lin Q, Ding KF, Zhao R, et al. Preoperative chemotherapy prior to primary tumour resection for asymptomatic synchronous unresectable colorectal liver-limited metastases: The RECUT multicenter randomised controlled trial[J]. Eur J Cancer, 2023, 191:112961. doi:10.1016/j.ejca.2023.112961. [102]Kobayashi K, Inoue Y, Oba A, et al. Strategies for recurrent colorectal liver metastases based on prognostic factors and resectability: potential benefit of multidisciplinary treatment[J]. Ann Surg Oncol, 2025, 32(3):1729-1741. doi:10.1245/s10434-024-16491-3. [103]Akgül Ö, Çetinkaya E, Ersöz Ş, et al. Role of surgery in colorectal cancer liver metastases[J]. World J Gastroenterol, 2014, 20(20):6113-6122. doi:10.3748/wjg.v20.i20.6113. [104]Zhu DX, Ren L, Wei Y, et al. Outcome of patients with colorectal liver metastasis: analysis of 1, 613 consecutive cases[J]. Ann Surg Oncol, 2012, 19(9):2860-2868. doi:10.1245/s10434-012-2356-9. [105]Rengers T, Warner S. Surgery for colorectal liver metastases: anatomic and non-anatomic approach[J]. Surgery, 2023, 174(1):119-122. doi:10.1016/j.surg.2023.02.032. [106]Kataoka K, Takahashi K, Takeuchi J, et al. Correlation between recurrence-free survival and overall survival after upfront surgery for resected colorectal liver metastases[J]. Br J Surg, 2023, 110(7):864-869. doi:10.1093/bjs/znad127. [107]Khan AS, Garcia-Aroz S, Ansari MA, et al. Assessment and optimization of liver volume before major hepatic resection: Current guidelines and a narrative review[J]. Int J Surg, 2018, 52:74-81. doi:10.1016/j.ijsu.2018.01.042. [108]Bégin A, Martel G, Lapointe R, et al. Accuracy of preoperative automatic measurement of the liver volume by CT-scan combined to a 3D virtual surgical planning software (3DVSP)[J]. Surg Endosc, 2014, 28(12):3408-3412. doi:10.1007/s00464-014-3611-x. [109]Takemura N, Ito K, Inagaki F, et al. Added value of indocyanine green fluorescence imaging in liver surgery[J]. Hepatobiliary Pancreat Dis Int, 2022, 21(4):310-317. doi:10.1016/j.hbpd.2021.12.007. [110]Yan TD, Padang R, Xia H, et al. Management of involved or close resection margins in 120 patients with colorectal liver metastases: edge cryotherapy can achieve long-term survival[J]. Am J Surg, 2006, 191(6):735-742. doi:10.1016/j.amjsurg.2005.05.055. [111]Pulitanò C, Bodingbauer M, Aldrighetti L, et al. Colorectal liver metastasis in the setting of lymph node metastasis: defining the benefit of surgical resection[J]. Ann Surg Oncol, 2012, 19(2):435-442. doi:10.1245/s10434-011-1902-1. [112]Margonis GA, Buettner S, Andreatos N, et al. Prognostic factors change over time after hepatectomy for colorectal liver metastases: a multi-institutional, international analysis of 1099 patients[J]. Ann Surg, 2019, 269(6):1129-1137. doi:10.1097/SLA.0000000000002664. [113]Zizzo M, Galeone C, Braglia L, et al. Long-term outcomes after surgical resection for synchronous or metachronous hepatic and pulmonary colorectal cancer metastases[J]. Digestion, 2020, 101(2):144-155. doi:10.1159/000497223. [114]Sharma S, Camci C, Jabbour N. Management of hepatic metastasis from colorectal cancers: an update[J]. J Hepatobiliary Pancreat Surg, 2008, 15(6):570-580. doi:10.1007/s00534-008-1350-x. [115]Capussotti L, Ferrero A, Viganò L, et al. Major liver resections synchronous with colorectal surgery[J]. Ann Surg Oncol, 2007, 14(1):195-201. doi:10.1245/s10434-006-9055-3. [116]Wu Y, Mao A, Wang H, et al. Association of simultaneous vs delayed resection of liver metastasis with complications and survival among adults with colorectal cancer[J]. JAMA Netw Open, 2022, 5(9):e2231956. doi:10.1001/jamanetworkopen.2022.31956. [117]Hatwell C, Bretagnol F, Farges O, et al. Laparoscopic resection of colorectal cancer facilitates simultaneous surgery of synchronous liver metastases[J]. Colorectal Dis, 2013, 15(1):e21-e28. doi:10.1111/codi.12068. [118]Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J]. Ann Surg, 2012, 255(3):405-414. doi:10.1097/SLA.0b013e31824856f5. [119]Nanji S, MacKillop WJ, Wei XJ, et al. Simultaneous resection of primary colorectal cancer and synchronous liver metastases: a population-based study[J]. Can J Surg, 2017, 60(2):122-128. doi:10.1503/cjs.008516. [120]Gumiero JL, Oliveira BMS, Neto PAO, et al. Timing of resection of synchronous colorectal liver metastasis: a systematic review and meta-analysis[J]. J Surg Oncol, 2022, 126(1):175-188. doi:10.1002/jso.26868. [121]Milazzo M, Todeschini L, Caimano M, et al. Surgical resection in colorectal liver metastasis: an umbrella review[J]. Cancers (Basel), 2024, 16(10):1849. doi:10.3390/cancers16101849. [122]Pelosi E, Deandreis D. The role of 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET) in the management of patients with colorectal cancer[J]. Eur J Surg Oncol, 2007, 33(1):1-6. doi:10.1016/j.ejso.2006.10.020. [123]Ayez N, Lalmahomed ZS, Eggermont AM, et al. Outcome of microscopic incomplete resection (R1) of colorectal liver metastases in the era of neoadjuvant chemotherapy[J]. Ann Surg Oncol, 2012, 19(5):1618-1627. doi:10.1245/s10434-011-2114-4. [124]Pandanaboyana S, White A, Pathak S, et al. Impact of margin status and neoadjuvant chemotherapy on survival, recurrence after liver resection for colorectal liver metastasis[J]. Ann Surg Oncol, 2015, 22(1):173-179. doi:10.1245/s10434-014-3953-6. [125]Adam R, Miller R, Pitombo M, et al. Two-stage hepatectomy approach for initially unresectable colorectal hepatic metastases[J]. Surg Oncol Clin N Am, 2007, 16(3):525-536. doi:10.1016/j.soc.2007.04.016. [126]Díaz Vico T, Granero Castro P, Alcover Navarro L, et al. Two stage hepatectomy (TSH) versus ALPPS for initially unresectable colorectal liver metastases: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2023, 49(3):550-559. doi:10.1016/j.ejso.2022.11.010. [127]Chebaro A, Buc E, Durin T, et al. Liver venous deprivation or associating liver partition and portal vein ligation for staged hepatectomy?: a retrospective multicentric study[J]. Ann Surg, 2021, 274(5):874-880. doi:10.1097/SLA.0000000000005121. [128]Abbasi A, Rahnemai-Azar AA, Merath K, et al. Role of associating liver partition and portal vein ligation in staged hepatectomy (ALPPS)-strategy for colorectal liver metastases[J]. Transl Gastroenterol Hepatol, 2018, 3:66. doi:10.21037/tgh.2018.09.03. [129]Bertens KA, Hawel J, Lung K, et al. ALPPS: challenging the concept of unresectability: a systematic review[J]. Int J Surg, 2015, 13:280-287. doi:10.1016/j.ijsu.2014.12.008. [130]Salem R, Garin E, Boucher E, et al. Optimal patient selection for yttrium-90 glass plus chemotherapy in the treatment of colorectal liver metastases: additional quality of life, efficacy, and safety analyses from the EPOCH study[J]. Oncologist, 2024, 29(8):681-689. doi:10.1093/oncolo/oyae128. [131]Azeredo-da-Silva ALF, de Jesus VHF, Agirrezabal I, et al. Selective internal radiation therapy using Y-90 resin microspheres for metastatic colorectal cancer: an updated systematic review and network meta-analysis[J]. Adv Ther, 2024, 41(4):1606-1620. doi:10.1007/s12325-024-02800-5. [132]Tabbal M, Alkhalifa AM, AlQattan AS, et al. Salvage liver transplantation after resection of colorectal cancer liver metastasis with favorable outcomes: a case report and review of the literature[J]. BMC Gastroenterol, 2021, 21(1):191. doi:10.1186/s12876-021-01778-6. [133]Adam R, Piedvache C, Chiche L, et al. Liver transplantation plus chemotherapy versus chemotherapy alone in patients with permanently unresectable colorectal liver metastases (TransMet): results from a multicentre, open-label, prospective, randomised controlled trial[J]. Lancet, 2024, 404(10458):1107-1118. doi:10.1016/S0140-6736(24)01595-2. [134]Ros J, Salva F, Dopazo C, et al. Liver transplantation in metastatic colorectal cancer: are we ready for it?[J]. Br J Cancer, 2023, 128(10):1797-1806. doi:10.1038/s41416-023-02213-1. [135]Takeda Y, Mise Y, Ito H, et al. Repeat resection for advanced colorectal liver metastases-does it have the potential for cure?[J]. World J Surg, 2022, 46(9):2253-2261. doi:10.1007/s00268-022-06616-8. [136]Kanzaki R, Higashiyama M, Oda K, et al. Outcome of surgical resection for recurrent pulmonary metastasis from colorectal carcinoma[J]. Am J Surg, 2011, 202(4):419-426. doi:10.1016/j.amjsurg.2010.08.016. [137]Carpizo DR, D'Angelica M. Liver resection for metastatic colorectal cancer in the presence of extrahepatic disease[J]. Ann Surg Oncol, 2009, 16(9):2411-2421. doi:10.1245/s10434-009-0493-6. [138]Hallemeier CL, Sharma N, Anker C, et al. American Radium Society Appropriate Use Criteria for the use of liver-directed therapies for nonsurgical management of liver metastases: Systematic review and guidelines[J]. Cancer, 2023, 129(20):3193-3212. doi:10.1002/cncr.34931. [139]van den Bemd BAT, Puijk RS, Keijzers H, et al. Mathematical 3D liver model for surgical versus ablative therapy treatment planning for colorectal liver metastases: recommendations from the COLLISION and COLDFIRE trial expert panels[J]. Radiol Imaging Cancer, 2024, 6(6):e240068. doi:10.1148/rycan.240068. [140]Li J, Pang C, Liu G, et al. Thermal ablation with and without adjuvant systemic therapy: a nationwide multicenter observational cohort study of solitary colorectal liver metastases[J]. Int J Surg, 2024, 110(7):4240-4248. doi:10.1097/JS9.0000000000001397. [141]Ceppa EP, Collings AT, Abdalla M, et al. SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm[J]. Surg Endosc, 2023, 37(12):8991-9000. doi:10.1007/s00464-023-10468-1. [142]Lukovic J, Dawson LA. Stereotactic body radiation therapy for colorectal cancer liver metastases[J]. J Gastrointest Oncol, 2024, 15(4):1917-1925. doi:10.21037/jgo-22-1183. [143]Yu J, Kim DH, Lee J, et al. Radiofrequency ablation versus stereotactic body radiation therapy in the treatment of colorectal cancer liver metastases[J]. Cancer Res Treat, 2022, 54(3):850-859. doi:10.4143/crt.2021.674. [144]Zhu C, Ren X, Liu D, et al. Oxaliplatin-induced hepatic sinusoidal obstruction syndrome[J]. Toxicology, 2021, 460:152882. doi:10.1016/j.tox.2021.152882. [145]Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases[J]. J Clin Oncol, 2006, 24(13):2065-2072. doi:10.1200/JCO.2005.05.3074. [146]Gomez D, Malik HZ, Bonney GK, et al. Steatosis predicts postoperative morbidity following hepatic resection for colorectal metastasis[J]. Br J Surg, 2007, 94(11):1395-1402. doi:10.1002/bjs.5820. [147]Nakano H, Oussoultzoglou E, Rosso E, et al. Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy[J]. Ann Surg, 2008, 247(1):118-124. doi:10.1097/SLA.0b013e31815774de. [148]Adam R, Wicherts DA, de Haas RJ, et al. Complete pathologic response after preoperative chemotherapy for colorectal liver metastases: myth or reality?[J]. J Clin Oncol, 2008, 26(10):1635-1641. doi:10.1200/JCO.2007.13.7471. [149]Horgan PG. Surgical management of disappearing colorectal liver metastases (Br J Surg 2013; 100:1414-1420)[J]. Br J Surg, 2013, 100(11):1420. doi:10.1002/bjs.9219. [150]Barimani D, Kauppila JH, Sturesson C, et al. Imaging in disappearing colorectal liver metastases and their accuracy: a systematic review[J]. World J Surg Oncol, 2020, 18(1):264. doi:10.1186/s12957-020-02037-w. [151]Leonard GD, Brenner B, Kemeny NE. Neoadjuvant chemotherapy before liver resection for patients with unresectable liver metastases from colorectal carcinoma[J]. J Clin Oncol, 2005, 23(9):2038-2048. doi:10.1200/JCO.2005.00.349. [152]Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy[J]. Ann Surg, 2004, 240(4):644-658. doi:10.1097/01.sla.0000141198.92114.f6. [153]Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage Ⅳ colorectal cancer receiving combination chemotherapy without surgery as initial treatment[J]. J Clin Oncol, 2009, 27(20):3379-3384. doi:10.1200/JCO.2008.20.9817. [154]Cheng XF, Zhao F, Chen D, et al. Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis[J]. World J Gastroenterol, 2024, 30(7):663-672. doi:10.3748/wjg.v30.i7.663. [155]Bernardi L, Roesel R, Aghayan DL, et al. Preoperative chemotherapy in upfront resectable colorectal liver metastases: New elements for an old dilemma?[J]. Cancer Treat Rev, 2024, 124:102696. doi:10.1016/j.ctrv.2024.102696. [156]Sarkar J, Attwood K, Schwarz RE. Perioperative chemotherapy is associated with superior overall survival in patients with synchronous colorectal liver metastases[J]. Ann Surg Oncol, 2023, 30(13):7986-7995. doi:10.1245/s10434-023-14302-9. [157]Li YJ, Tan LX, Chen N, et al. Neoadjuvant immunotherapy alone for patients with locally advanced and resectable metastatic colorectal cancer of dMMR/MSI-H status[J]. Dis Colon Rectum, 2024, 67(11):1413-1422. doi:10.1097/DCR.0000000000003290. [158]Gruenberger B, Tamandl D, Schueller J, et al. Bevacizumab, capecitabine, and oxaliplatin as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer[J]. J Clin Oncol, 2008, 26(11):1830-1835. doi:10.1200/JCO.2007.13.7679. [159]Parkin E, O'Reilly DA, Adam R, et al. The effect of hepatic steatosis on survival following resection of colorectal liver metastases in patients without preoperative chemotherapy[J]. HPB (Oxford), 2013, 15(6):463-472. doi:10.1111/hpb.12007. [160]Clancy TE, Dixon E, Perlis R, et al. Hepatic arterial infusion after curative resection of colorectal cancer metastases: a meta-analysis of prospective clinical trials[J]. J Gastrointest Surg, 2005, 9(2):198-206. doi:10.1016/j.gassur.2004.07.004. [161]Kemeny N, Eid A, Stockman J, et al. Hepatic arterial infusion of floxuridine and dexamethasone plus high-dose Mitomycin C for patients with unresectable hepatic metastases from colorectal carcinoma[J]. J Surg Oncol, 2005, 91(2):97-101. doi:10.1002/jso.20286. [162]Kemeny N, Jarnagin W, Paty P, et al. Phase I trial of systemic oxaliplatin combination chemotherapy with hepatic arterial infusion in patients with unresectable liver metastases from colorectal cancer[J]. J Clin Oncol, 2005, 23(22):4888-4896. doi:10.1200/JCO.2005.07.100. [163]Zaidi MY, Nussbaum DP, Hsu SD, et al. Hepatic artery infusion for unresectable colorectal cancer liver metastases: Palliation and conversion[J]. Surgery, 2023, 174(2):428-430. doi:10.1016/j.surg.2023.04.025. [164]Kishi Y, Zorzi D, Contreras CM, et al. Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases[J]. Ann Surg Oncol, 2010, 17(11):2870-2876. doi:10.1245/s10434-010-1166-1. [165]Hoogteijling TJ, Abu Hilal M, Zimmitti G, et al. Impact of neoadjuvant chemotherapy on short-term outcomes after simple and complex minimally invasive minor hepatectomy for colorectal liver metastases: a propensity-score matched and coarsened exact matched study[J]. Eur J Surg Oncol, 2024, 50(6):108309. doi:10.1016/j.ejso.2024.108309. [166]Tepelenis K, Pappas-Gogos G, Ntellas P, et al. The role of preoperative chemotherapy in the management of synchronous resectable colorectal liver metastases: a meta-analysis[J]. Curr Oncol, 2023, 30(5):4499-4511. doi:10.3390/curroncol30050340. [167]Benoist S, Nordlinger B. The role of preoperative chemotherapy in patients with resectable colorectal liver metastases[J]. Ann Surg Oncol, 2009, 16(9):2385-2390. doi:10.1245/s10434-009-0492-7. [168]Choti MA. Chemotherapy-associated hepatotoxicity: do we need to be concerned?[J]. Ann Surg Oncol, 2009, 16(9):2391-2394. doi:10.1245/s10434-009-0512-7. [169]Samantas E, Dervenis C, Rigatos SK. Adjuvant chemotherapy for colon cancer: evidence on improvement in survival[J]. Dig Dis, 2007, 25(1):67-75. doi:10.1159/000099172. [170]Benoist S, Nordlinger B. Neoadjuvant treatment before resection of liver metastases[J]. Eur J Surg Oncol, 2007, 33(Suppl 2):S35-S41. doi:10.1016/j.ejso.2007.09.022. [171]Adam R, Bhangui P, Poston G, et al. Is perioperative chemotherapy useful for solitary, metachronous, colorectal liver metastases?[J]. Ann Surg, 2010, 252(5):774-787. doi:10.1097/SLA.0b013e3181fcf3e3. [172]Schwarz RE, Berlin JD, Lenz HJ, et al. Systemic cytotoxic and biological therapies of colorectal liver metastases: expert consensus statement[J]. HPB (Oxford), 2013, 15(2):106-115. doi:10.1111/j.1477-2574.2012.00558.x. [173]De Greef K, Rolfo C, Russo A, et al. Multisciplinary management of patients with liver metastasis from colorectal cancer[J]. World J Gastroenterol, 2016, 22(32):7215-7225. doi:10.3748/wjg.v22.i32.7215. [174]Goéré D, Benhaim L, Bonnet S, et al. Adjuvant chemotherapy after resection of colorectal liver metastases in patients at high risk of hepatic recurrence: a comparative study between hepatic arterial infusion of oxaliplatin and modern systemic chemotherapy[J]. Ann Surg, 2013, 257(1):114-120. doi:10.1097/SLA.0b013e31827b9005. [175]House MG, Kemeny NE, Gönen M, et al. Comparison of adjuvant systemic chemotherapy with or without hepatic arterial infusional chemotherapy after hepatic resection for metastatic colorectal cancer[J]. Ann Surg, 2011, 254(6):851-856. doi:10.1097/SLA.0b013e31822f4f88. [176]Kemeny NE, Jarnagin WR, Capanu M, et al. Randomized phase Ⅱ trial of adjuvant hepatic arterial infusion and systemic chemotherapy with or without bevacizumab in patients with resected hepatic metastases from colorectal cancer[J]. J Clin Oncol, 2011, 29(7):884-889. doi:10.1200/JCO.2010.32.5977. [177]Abdalla EK. Commentary: radiofrequency ablation for colorectal liver metastases: do not blame the biology when it is the technology[J]. Am J Surg, 2009, 197(6):737-739. doi:10.1016/j.amjsurg.2008.06.029. [178]Folprecht G, Gruenberger T, Bechstein WO, et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial[J]. Lancet Oncol, 2010, 11(1):38-47. doi:10.1016/S1470-2045(09)70330-4. [179]Adam R. Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases[J]. Ann Oncol, 2003, 14(Suppl 2):ii13-ii16. doi:10.1093/annonc/mdg731. [180]Goldberg RM, Sargent DJ, Morton RF, et al. Randomized controlled trial of reduced-dose bolus fluorouracil plus leucovorin and irinotecan or infused fluorouracil plus leucovorin and oxaliplatin in patients with previously untreated metastatic colorectal cancer: a North American Intergroup Trial[J]. J Clin Oncol, 2006, 24(21):3347-3353. doi:10.1200/JCO.2006.06.1317. [181]Cals L, Rixe O, François E, et al. Dose-finding study of weekly 24-h continuous infusion of 5-fluorouracil associated with alternating oxaliplatin or irinotecan in advanced colorectal cancer patients[J]. Ann Oncol, 2004, 15(7):1018-1024. doi:10.1093/annonc/mdh259. [182]Falcone A, Ricci S, Brunetti I, et al. Phase Ⅲ trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest[J]. J Clin Oncol, 2007, 25(13):1670-1676. doi:10.1200/JCO.2006.09.0928. [183]Tournigand C, André T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study[J]. J Clin Oncol, 2004, 22(2):229-237. doi:10.1200/JCO.2004.05.113. [184]Hochster HS, Hart LL, Ramanathan RK, et al. Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study[J]. J Clin Oncol, 2008, 26(21):3523-3529. doi:10.1200/JCO.2007.15.4138. [185]André T, Shiu KK, Kim TW, et al. Pembrolizumab in microsatellite-instability-high advanced colorectal cancer[J]. N Engl J Med, 2020, 383(23):2207-2218. doi:10.1056/NEJMoa2017699. [186]Andre T, Amonkar M, Norquist JM, et al. Health-related quality of life in patients with microsatellite instability-high or mismatch repair deficient metastatic colorectal cancer treated with first-line pembrolizumab versus chemotherapy (KEYNOTE-177): an open-label, randomised, phase 3 trial[J]. Lancet Oncol, 2021, 22(5):665-677. doi:10.1016/S1470-2045(21)00064-4. [187]Le DT, Uram JN, Wang H, et al. PD-1 blockade in tumors with mismatch-repair deficiency[J]. N Engl J Med, 2015, 372(26):2509-2520. doi:10.1056/NEJMoa1500596. [188]Marabelle A, Le DT, Ascierto PA, et al. Efficacy of pembrolizumab in patients with noncolorectal high microsatellite instability/mismatch repair-deficient cancer: results from the phase Ⅱ KEYNOTE-158 study[J]. J Clin Oncol, 2020, 38(1):1-10. doi:10.1200/JCO.19.02105. [189]Lenz HJ, Van Cutsem E, Luisa Limon M, et al. First-line nivolumab plus low-dose ipilimumab for microsatellite instability-high/mismatch repair-deficient metastatic colorectal cancer: the phase Ⅱ CheckMate 142 study[J]. J Clin Oncol, 2022, 40(2):161-170. doi:10.1200/JCO.21.01015. [190]Le DT, Kim TW, Van Cutsem E, et al. Phase Ⅱ open-label study of pembrolizumab in treatment-refractory, microsatellite instability-high/mismatch repair-deficient metastatic colorectal cancer: keynote-164[J]. J Clin Oncol, 2020, 38(1):11-19. doi:10.1200/JCO.19.02107. [191]Piessevaux H, Buyse M, Schlichting M, et al. Use of early tumor shrinkage to predict long-term outcome in metastatic colorectal cancer treated with cetuximab[J]. J Clin Oncol, 2013, 31(30):3764-3775. doi:10.1200/JCO.2012.42.8532. [192]Suzuki C, Blomqvist L, Sundin A, et al. The initial change in tumor size predicts response and survival in patients with metastatic colorectal cancer treated with combination chemotherapy[J]. Ann Oncol, 2012, 23(4):948-954. doi:10.1093/annonc/mdr350. [193]Ye LC, Wei Y, Zhu DX, et al. Impact of early tumor shrinkage on clinical outcome in wild-type-KRAS colorectal liver metastases treated with cetuximab[J]. J Gastroenterol Hepatol, 2015, 30(4):674-679. doi:10.1111/jgh.12847. [194]Alberts SR, Horvath WL, Sternfeld WC, et al. Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer: a North Central Cancer Treatment Group phase Ⅱ study[J]. J Clin Oncol, 2005, 23(36):9243-9249. doi:10.1200/JCO.2005.07.740. [195]Pernot S, Artru P, Mithieux F, et al. Complete pathological response of unresectable liver metastases from colorectal cancer after trans-arterial chemoembolization with drug-eluting beads loaded with irinotecan (DEBIRI) and concomitant systemic FOLFOX: a case report from the FFCD 1201 trial[J]. Clin Res Hepatol Gastroenterol, 2015, 39(6):e73-e77. doi:10.1016/j.clinre.2015.06.004. [196]Tang W, Ren L, Liu T, et al. Bevacizumab plus mFOLFOX6 versus mFOLFOX6 alone as first-line treatment for RAS mutant unresectable colorectal liver-limited metastases: the BECOME randomized controlled trial[J]. J Clin Oncol, 2020, 38(27):3175-3184. doi:10.1200/JCO.20.00174. [197]Ye LC, Liu TS, Ren L, et al. Randomized controlled trial of cetuximab plus chemotherapy for patients with KRAS wild-type unresectable colorectal liver-limited metastases[J]. J Clin Oncol, 2013, 31(16):1931-1938. doi:10.1200/JCO.2012.44.8308. [198]Hu H, Wang K, Huang M, et al. Modified FOLFOXIRI with or without cetuximab as conversion therapy in patients with RAS/BRAF wild-type unresectable liver metastases colorectal cancer: the FOCULM multicenter phase Ⅱ trial[J]. Oncologist, 2021, 26(1):e90-e98. doi:10.1634/theoncologist.2020-0563. [199]Van Cutsem E, Köhne CH, Hitre E, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer[J]. N Engl J Med, 2009, 360(14):1408-1417. doi:10.1056/NEJMoa0805019. [200]Garufi C, Torsello A, Tumolo S, et al. Cetuximab plus chronomodulated irinotecan, 5-fluorouracil, leucovorin and oxaliplatin as neoadjuvant chemotherapy in colorectal liver metastases: POCHER trial[J]. Br J Cancer, 2010, 103(10):1542-1547. doi:10.1038/sj.bjc.6605940. [201]Souglakos J, Androulakis N, Syrigos K, et al. FOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin and irinotecan) vs FOLFIRI (folinic acid, 5-fluorouracil and irinotecan) as first-line treatment in metastatic colorectal cancer (MCC): a multicentre randomised phase Ⅲ trial from the Hellenic Oncology Research Group (HORG)[J]. Br J Cancer, 2006, 94(6):798-805. doi:10.1038/sj.bjc.6603011. [202]Cremolini C, Antoniotti C, Rossini D, et al. Upfront FOLFOXIRI plus bevacizumab and reintroduction after progression versus mFOLFOX6 plus bevacizumab followed by FOLFIRI plus bevacizumab in the treatment of patients with metastatic colorectal cancer (TRIBE2): a multicentre, open-label, phase 3, randomised, controlled trial[J]. Lancet Oncol, 2020, 21(4):497-507. doi:10.1016/S1470-2045(19)30862-9. [203]Cremolini C, Loupakis F, Antoniotti C, et al. FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study[J]. Lancet Oncol, 2015, 16(13):1306-1315. doi:10.1016/S1470-2045(15)00122-9. [204]Stein A, Atanackovic D, Hildebrandt B, et al. Upfront FOLFOXIRI+bevacizumab followed by fluoropyrimidin and bevacizumab maintenance in patients with molecularly unselected metastatic colorectal cancer[J]. Br J Cancer, 2015, 113(6):872-877. doi:10.1038/bjc.2015.299. [205]Tomasello G, Petrelli F, Ghidini M, et al. FOLFOXIRI plus bevacizumab as conversion therapy for patients with initially unresectable metastatic colorectal cancer: a systematic review and pooled analysis[J]. JAMA Oncol, 2017, 3(7):e170278. doi:10.1001/jamaoncol.2017.0278. [206]Karapetis CS, Jonker D, Daneshmand M, et al. PIK3CA, BRAF, and PTEN status and benefit from cetuximab in the treatment of advanced colorectal cancer: results from NCIC CTG/AGITG CO.17[J]. Clin Cancer Res, 2014, 20(3):744-753. doi:10.1158/1078-0432.CCR-13-0606. [207]Cleary JM, Tanabe KT, Lauwers GY, et al. Hepatic toxicities associated with the use of preoperative systemic therapy in patients with metastatic colorectal adenocarcinoma to the liver[J]. Oncologist, 2009, 14(11):1095-1105. doi:10.1634/theoncologist.2009-0152. [208]Esin E, Yalcin S. Maintenance strategy in metastatic colorectal cancer: a systematic review[J]. Cancer Treat Rev, 2016, 42:82-90. doi:10.1016/j.ctrv.2015.10.012. [209]Goey KKH, Elias SG, van Tinteren H, et al. Maintenance treatment with capecitabine and bevacizumab versus observation in metastatic colorectal cancer: updated results and molecular subgroup analyses of the phase 3 CAIRO3 study[J]. Ann Oncol, 2017, 28(9):2128-2134. doi:10.1093/annonc/mdx322. [210]Hegewisch-Becker S, Graeven U, Lerchenmüller CA, et al. Maintenance strategies after first-line oxaliplatin plus fluoropyrimidine plus bevacizumab for patients with metastatic colorectal cancer (AIO 0207): a randomised, non-inferiority, open-label, phase 3 trial[J]. Lancet Oncol, 2015, 16(13):1355-1369. doi:10.1016/S1470-2045(15)00042-X. [211]Simkens LH, van Tinteren H, May A, et al. Maintenance treatment with capecitabine and bevacizumab in metastatic colorectal cancer (CAIRO3): a phase 3 randomised controlled trial of the Dutch Colorectal Cancer Group[J]. Lancet, 2015, 385(9980):1843-1852. doi:10.1016/S0140-6736(14)62004-3. [212]Stein A, Schwenke C, Folprecht G, et al. Effect of application and intensity of bevacizumab-based maintenance after induction chemotherapy with bevacizumab for metastatic colorectal cancer: a meta-analysis[J]. Clin Colorectal Cancer, 2016, 15(2):e29-e39. doi:10.1016/j.clcc.2015.12.005. [213]Sonbol MB, Mountjoy LJ, Firwana B, et al. The role of maintenance strategies in metastatic colorectal cancer: a systematic review and network meta-analysis of randomized clinical trials[J]. JAMA Oncol, 2020, 6(3):e194489. doi:10.1001/jamaoncol.2019.4489. [214]Aparicio T, Ghiringhelli F, Boige V, et al. Bevacizumab maintenance versus No maintenance during chemotherapy-free intervals in metastatic colorectal cancer: a randomized phase Ⅲ trial (PRODIGE 9)[J]. J Clin Oncol, 2018, 36(7):674-681. doi:10.1200/JCO.2017.75.2931. [215]Xu RH, Muro K, Morita S, et al. Modified XELIRI (capecitabine plus irinotecan) versus FOLFIRI (leucovorin, fluorouracil, and irinotecan), both either with or without bevacizumab, as second-line therapy for metastatic colorectal cancer (AXEPT): a multicentre, open-label, randomised, non-inferiority, phase 3 trial[J]. Lancet Oncol, 2018, 19(5):660-671. doi:10.1016/S1470-2045(18)30140-2. [216]Ducreux M, Malka D, Mendiboure J, et al. Sequential versus combination chemotherapy for the treatment of advanced colorectal cancer (FFCD 2000–05): an open-label, randomised, phase 3 trial[J]. Lancet Oncol, 2011, 12(11):1032-1044. doi:10.1016/S1470-2045(11)70199-1. [217]Koopman M, Antonini NF, Douma J, et al. Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (CAIRO): a phase Ⅲ randomised controlled trial[J]. Lancet, 2007, 370(9582):135-142. doi:10.1016/S0140-6736(07)61086-1. [218]Seymour MT, Maughan TS, Ledermann JA, et al. Different strategies of sequential and combination chemotherapy for patients with poor prognosis advanced colorectal cancer (MRC FOCUS): a randomised controlled trial[J]. Lancet, 2007, 370(9582):143-152. doi:10.1016/S0140-6736(07)61087-3. [219]Mayer RJ, Van Cutsem E, Falcone A, et al. Randomized trial of TAS-102 for refractory metastatic colorectal cancer[J]. N Engl J Med, 2015, 372(20):1909-1919. doi:10.1056/NEJMoa1414325. [220]Shitara K, Doi T, Dvorkin M, et al. Trifluridine/tipiracil versus placebo in patients with heavily pretreated metastatic gastric cancer (TAGS): a randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet Oncol, 2018, 19(11):1437-1448. doi:10.1016/S1470-2045(18)30739-3. [221]Grothey A, Van Cutsem E, Sobrero A, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial[J]. Lancet, 2013, 381(9863):303-312. doi:10.1016/S0140-6736(12)61900-X. [222]Li J, Qin S, Xu RH, et al. Effect of fruquintinib vs placebo on overall survival in patients with previously treated metastatic colorectal cancer: the FRESCO randomized clinical trial[J]. JAMA, 2018, 319(24):2486-2496. doi:10.1001/jama.2018.7855. [223]Bennouna J, Borg C, Delord JP, et al. Bevacizumab combined with chemotherapy in the second-line treatment of metastatic colorectal cancer: results from the phase Ⅱ BEVACOLOR study[J]. Clin Colorectal Cancer, 2012, 11(1):38-44. doi:10.1016/j.clcc.2011.05.002. [224]Iwamoto S, Hazama S, Kato T, et al. Multicenter phase Ⅱ study of second-line cetuximab plus folinic acid/5-fluorouracil/irinotecan (FOLFIRI) in KRAS wild-type metastatic colorectal cancer: the FLIER study[J]. Anticancer Res, 2014, 34(4):1967-1973. [225]Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer[J]. N Engl J Med, 2004, 350(23):2335-2342. doi:10.1056/NEJMoa032691. [226]Jin Z, Sinicrope FA. Advances in the therapy of BRAFV600E metastatic colorectal cancer[J]. Expert Rev Anticancer Ther, 2019, 19(9):823-829. doi:10.1080/14737140.2019.1661778. [227]Tabernero J, Grothey A, Van Cutsem E, et al. Encorafenib plus cetuximab as a new standard of care for previously treated BRAF V600E-mutant metastatic colorectal cancer: updated survival results and subgroup analyses from the BEACON study[J]. J Clin Oncol, 2021, 39(4):273-284. doi:10.1200/JCO.20.02088. [228]Kopetz S, Guthrie KA, Morris VK, et al. Randomized trial of irinotecan and cetuximab with or without vemurafenib in BRAF-mutant metastatic colorectal cancer (SWOG S1406)[J]. J Clin Oncol, 2021, 39(4):285-294. doi:10.1200/JCO.20.01994. [229]Meric-Bernstam F, Hurwitz H, Raghav KPS, et al. Pertuzumab plus trastuzumab for HER2-amplified metastatic colorectal cancer (MyPathway): an updated report from a multicentre, open-label, phase 2a, multiple basket study[J]. Lancet Oncol, 2019, 20(4):518-530. doi:10.1016/S1470-2045(18)30904-5. [230]Sartore-Bianchi A, Trusolino L, Martino C, et al. Dual-targeted therapy with trastuzumab and lapatinib in treatment-refractory, KRAS Codon 12/13 wild-type, HER2-positive metastatic colorectal cancer (HERACLES): a proof-of-concept, multicentre, open-label, phase 2 trial[J]. Lancet Oncol, 2016, 17(6):738-746. doi:10.1016/S1470-2045(16)00150-9. [231]Siena S, Di Bartolomeo M, Raghav K, et al. Trastuzumab deruxtecan (DS-8201) in patients with HER2-expressing metastatic colorectal cancer (DESTINY-CRC01): a multicentre, open-label, phase 2 trial[J]. Lancet Oncol, 2021, 22(6):779-789. doi:10.1016/S1470-2045(21)00086-3. [232]Suwaidan AA, Lau DK, Chau I. HER2 targeted therapy in colorectal cancer: New horizons[J]. Cancer Treat Rev, 2022, 105:102363. doi:10.1016/j.ctrv.2022.102363. [233]D'Angelica MI, Correa-Gallego C, Paty PB, et al. Phase Ⅱ trial of hepatic artery infusional and systemic chemotherapy for patients with unresectable hepatic metastases from colorectal cancer: conversion to resection and long-term outcomes[J]. Ann Surg, 2015, 261(2):353-360. doi:10.1097/SLA.0000000000000614. [234]Qi MD, Tao ZJ, Yu D, et al. Complications of transarterial radioembolization in hepatic malignancies: Pathophysiological insights and management paradigms[J]. Eur J Radiol, 2025, 190:112224. doi:10.1016/j.ejrad.2025.112224. [235]Kong YQ, Huang XY, Peng G, et al. Efficacy of first-line radiofrequency ablation combined with systemic chemotherapy plus targeted therapy for initially unresectable colorectal liver metastases[J]. Int J Hyperthermia, 2025, 42(1):2432988. doi:10.1080/02656736.2024.2432988. [236]Connell LC, Kemeny NE. Intraarterial chemotherapy for liver metastases[J]. Hematol Oncol Clin North Am, 2025, 39(1):143-159. doi:10.1016/j.hoc.2024.08.005. [237]Arnold D, Pereira PL, Iezzi R, et al. Transarterial chemoembolisation with irinotecan (irinotecan-TACE) as salvage or post-inductive therapy for colorectal cancer liver metastases: effectiveness results from the CIREL study[J]. ESMO Open, 2025, 10(3):104292. doi:10.1016/j.esmoop.2025.104292. [238]Swierz MJ, Storman D, Mitus JW, et al. Transarterial (chemo)embolisation versus systemic chemotherapy for colorectal cancer liver metastases[J]. Cochrane Database Syst Rev, 2024, 8(8):CD012757. doi:10.1002/14651858.CD012757.pub2. [239]Sugumar K, Stitzel H, Wu V, et al. Outcomes of hepatic artery-based therapies and systemic multiagent chemotherapy in unresectable colorectal liver metastases: a systematic review and meta-analysis[J]. Ann Surg Oncol, 2024, 31(7):4413-4426. doi:10.1245/s10434-024-15187-y. （本文编辑　姜晖） 本文引用格式：中国医师协会外科医师分会；中华医学会外科分会胃肠外科学组；中华医学会外科分会结直肠外科学组；等. 结直肠癌肝转移诊断和综合治疗指南（2025版）[J]. 中国普通外科杂志, 2025, 34(8):1565-1588. doi：10.7659/j.issn.1005-6947.250402 Cite this article as: Chinese Society of Surgeons, Chinese Medical Doctor Association; Gastrointestinal Surgery Group, Chinese Society of Surgery, Chinese Medical Association; Colorectal Surgery Group, Chinese Society of Surgery, Chinese Medical Association; et al.  Chinese guidelines for the diagnosis and comprehensive treatment of colorectal liver metastases (2025 edition)[J]. Chin J Gen Surg, 2025, 34(8):1565-1588. doi：10.7659/j.issn.1005-6947.250402 排版 黎明梅 初审 熊　杨 复审 宋　涛 终审 姜　晖 版权声明 本文为《中国普通外科杂志》原创文章，版权归中国普通外科杂志所有。其他媒体、网站、公众号等如需转载本文，请联系本刊编辑部获得授权，并在文题下醒目位置注明“原文刊发于《中国普通外科杂志》，卷（期）：起止页码”。谢谢合作！

相关指南

引用 / 出处

中国普通外科杂志. 结直肠癌肝转移诊断和综合治疗指南（2025版）[S/OL]. 2025.