| Abstract | Jetra je najčešće sijelo metastaza različitih tumora iz cijeloga tijela, a poglavito tumora debeloga crijeva. Funkcija jetre kao glavnog sabirnog organa svih tvari iz probavnog sustava čine ju veoma privlačnom za maligne stanice. U jednoj trećini slučajeva bolesnici već u trenutku otkrivanja primarnoga tumora kolorektuma imaju prisutne metastaze u jetri, u drugoj trećini će se naknado dijagnosticirati u praćenju bolesnika, a kod treće trećine se nikada neće ni pojaviti. Problem metastatske bolesti kod takvih bolesnika ima ključnu ulogu u liječenju i daljnjoj prognozi. U današnje vrijeme tehnološkoga napretka i sveukupnog unaprijeđenja svake grane medicine postoji mnogo pristupa i modaliteta liječenja jetrenih metastaza, ali i dalje ključnu ulogu ima klasična kirurgija. Čak i unutar klasične kirurgije postoji više pristupa za odstranjenje, tj. resekciju tumorskoga tkiva. Nove spoznaje o fiziologiji jetre te o ponašanju malignih stanica uvelike su promijenile klasične operativne metode i doprinijele boljim rezultatima preživljavanja i boljoj kvaliteti života pacijenata. Važno je spomenuti i da se unatoč tome napretku mora poštivati načelo individualnosti i svakome pacijentu pristupati zasebno. Dopunske metode poput embolizacije portalne vene ili ligature portalne vene također su poboljšale rezultate kirurškoga liječenja te u nekim slučajevima neoperabilno stanje učinile operabilnim. Novim farmakološkim spoznajama i razvitkom velikog broja tzv. „pametnih lijekova“ poboljšalo se i kemoterapijsko liječenje tumora. Zajedno sa komplementarnim metodama kao što je radiofrekventna ablacija danas je moguć i palijativni pristup liječenju jetrenih metastaza i poboljšanje kvalitete preostaloga života u terminalnih pacijenata, što unazad nekoliko desetljeća nije bio slučaj. U skoroj budućnosti bit će moguć minimalno invazivni ili laparoskopski pristup kako malignim bolestima općenito tako i jetrenim metastazama na što je dan osvrt u ovome radu. Zaključno treba napomenuti da je kirurgija bila i ostala glavna kurativna metoda jetrenih metastaza i da su sve ostale metode zapravo komplementarne metode koje trebaju biti kombinirane s kirurškim tretmanom, a nikako altrenativne metode kirurgiji. |
| Abstract (english) | The liver is the most common site of metastases from various tumours situated
anywhere in the body, particularly of those caused by colorectal tumours. Its role as the
primary collector of all substances from the digestive system makes the liver a highly
attractive target for malignant cells. A third of the patients already present with liver
metastases at the time they are diagnosed with primary colorectal tumour, in another
third they will be detected during patient follow-up, while in the remaining third they will
never develop. The status of metastatic disease in such patients is key to determining
the course of treatment and the prognosis. Today, thanks to the technological advances
and to the general progress of all branches of medicine, we have at our disposal a wide
array of approaches to and modalities of treatment of liver metastases, but the role of
classical surgery is still crucial. Even within classical surgery there are a number of
tumour tissue removal (i.e. resection) procedures. Recent insights into the physiology of
the liver and the behaviour of malignant cells have greatly impacted the classical
operative methods, also increasing the survival rates and improving the patients’ quality
of life. It is important to note that despite these advances the principle of individuality has
to be respected, and each patient has to be approached specific to his or her needs.
Complementary methods such as portal vein embolisation and portal vein ligature have
also improved the results of surgical treatment, and in some cases have converted
inoperable cases into operable ones. As a result of new discoveries in pharmacology
and of the development of a large number of the so-called “smart drugs”, the
chemotherapeutic treatment of tumours has also improved. Together with
complementary methods such as radiofrequency ablation, today a palliative approach to
liver metastases treatment is possible, improving the quality of the remaining lifetime for
terminal patients, which a couple of decades ago was not the case. In the near future,
minimally invasive and laparoscopic approaches to liver metastases and malignant
diseases in general will be made possible; we discuss these in the present paper.
Finally, it should be emphasised that surgery has been the curative method of choice for
liver metastases, while all the other methods are purely complementary and as such are
to be applied in combination with surgical treatment, never as alternatives to surgery. |
