Pathological assessment of malignant polyps varies between observers. Specialist pathologists appear to have a higher degree of consensus among themselves than with generalist pathologists with respect to T stage. The high interobserver variability with regard to histological grade of differentiated tumours is clinically irrelevant. However, variability in the assessment of angiolymphatic vessel invasion limits the value of this measurement for clinical decision making.

Many studies have been conducted to determine prognosis on the basis of the characteristics of metastatic liver tumor from colorectal cancer. The present study was carried out to determine whether the pathological mode of infiltrative growth (INF) of a metastatic liver nodule is useful in predicting recurrence in the remnant liver after hepatic resection. A total of 42 curative hepatic resections were performed for 37 patients with isolated liver metastases from colorectal cancer. Multivariate analysis (n = 42) showed that number, INF type, and size of liver metastases were statistically significant as independent risk factors. Of these, 28 resected liver metastases (smaller than 6 cm in size or containing fewer than 4 nodules) were classified pathologically into INF alpha or beta types (INF a b; n = 14) and gamma type (INFg; n = 14). Disease-free survival at 5 years was 64% for patients with INF a b type, and 14% for those with the INF g type of liver metastases. Of these, recurrent disease of the liver after hepatic resection was found in 2 (14%) and 11 (79%) patients with INF a b and INF g types, respectively. From these observations, we concluded that pathological infiltrative growth of liver metastases is an informative predictor of disease-free survival and especially of recurrence in the remnant liver.

The present study was performed to assess survival benefits in patients who underwent a hepatic resection for isolated bilobar liver metastases from colorectal cancer. Thirty-eight patients underwent a curative hepatic resection for isolated colorectal liver metastasis. Among them, 11 patients had bilobar liver metastases and 19 had a solitary metastasis. The remaining 8 patients had unilobar multiple lesions. We investigated survival in two groups those with bilobar and those with solitary metastatic tumors. Survival and disease-free survival were 36% and 18% at 5 years, respectively, in the patients with bilobar liver metastases, while these survivals were 43% and 34% in the patients with solitary liver metastasis. In the 38 patients, repeated hepatic resections were performed in 15 patients with recurrent liver disease. The 5-year survival and disease-free survival rates for these patients were 38% and 27%, respectively, after the second hepatic resections. Of the 11 patients with bilobar liver metastases, 5 underwent a repeated hepatic resection, and they all survived for over 42 months. Based on our observations, a hepatic resection was thus found to be effective even in selected patients with either bilobar nodules or recurrence in the remnant liver.

Background: We recently reported that the pathologic mode of infiltrative growth (infiltrative [INF]-␣, INF-␤, and INF-␥) of colorectal liver metastases had characteristic morphologic findings, and furthermore showed that the INF type was a prognostic factor for diseasefree survival after hepatic resection. Hypothesis: Preoperative computed tomographic (CT) findings of the liver nodules may be predictive for pathologic tumor growth pattern.

We report herein the case of a 63-year-old man with cancer of the sigmoid colon and metastatic nodules in the liver who was effectively treated with a combination of cisplatin regional chemotherapy, given through the hepatic artery, in conjunction with a 3-week course of intravenous gamma-interferon (INF-gamma), following palliative sigmoidectomy and dissection of the regional lymph nodes. This was followed-up by a 3-month course of oral 5-fluorouracil. Hepatic imaging performed 6 months postoperatively showed no masses in the right hepatic lobe and an apparent decrease in the size of the tumor in the left lobe. A second-look operation with resection performed at this time confirmed the efficacy of the chemotherapy. The patient survived in excess of 30 months following his initial surgery before succumbing to hepatic failure.