Kolorektal Kanser Karaciğer Metastazı
Özet
Kolorektal kanserlerin en sık metastaz yaptığı organ karaciğerdir ve rezeksiyon uygulanan hastalarda sağkalım süreleri belirgin şekilde artmaktadır. Preoperatif dönemde BT ve MRI, metastazların dağılımını ve ekstrahepatik hastalığı değerlendirmede temel görüntüleme yöntemleridir. Cerrahi kararında teknik rezektabilitenin yanı sıra mutasyon durumu (KRAS, BRAF) ve preoperatif tedaviye yanıt gibi onkolojik kriterler de kritik öneme sahiptir. Perioperatif kemoterapi rejimleri ilerleme sağlasa da karaciğerde steatoz ve sinüzoidal hasar gibi toksisitelere yol açabilir. Multifokal bilateral metastazlarda, portal ven embolizasyonu ve iki aşamalı cerrahi gibi yöntemlerle korunacak karaciğer hacmi artırılarak rezeksiyon şansı tanınmaktadır. Cerrahi ve yoğun bakım olanaklarındaki gelişmeler sayesinde ameliyat sonrası morbidite ve mortalite oranları hızla azalmaktadır.
The liver is the most common site for colorectal cancer metastasis, and surgical resection significantly improves patient survival. Preoperatively, CT and MRI are the primary imaging modalities used to evaluate lesion distribution and extrahepatic disease. Surgical decision-making relies on both technical resectability and oncologic factors, such as mutation status (KRAS, BRAF) and response to preoperative therapy. Although perioperative chemotherapy extends survival, it can induce liver toxicities like steatosis and sinusoidal obstruction syndrome. For multifocal bilateral metastases, strategies like portal vein embolization and two-stage hepatectomy increase the future liver remnant, enabling resection. Advances in surgical techniques and postoperative care have successfully decreased overall morbidity and mortality rates.
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