Hepatic resections for colorectal metastases: The italian multicenter experience

Abstract

In 1989 there were 151,000 new cases of colorectal carcinoma in the United States. Approximately 50% of these patients will be at risk of developing liver metastases together with other sites of recurrence. However, the liver will be the main site of relapse in only 14,000 patients with colorectal cancer. [1,2,12,15,19]. Approximately 25% of patients with colorectal carcinoma have technically resectable hepatic metastases at the time of operation for primary lesion, and an additional 8-25% will develop metachronous hepatic metastases after primary resection [ 15,251. Recent reported experiences with surgical treatment of metastatic colorectal cancer in the liver seem to indicate that hepatic resection has become more acceptable, safe and effective therapy, and offers today when technically possible, the best prospect of survival in a conspicuous number of patients. For these reasons, although a prospective randomized trial has not been done comparing resection with nonresection, resection seems to give the best hope for cure and actually is the treatment of choice for selected patients. In fact in these patients is reported a significant prolongation of survival compared with those patients with unresectable liver metastases treated only with adjuvant therapy in the form of chemotherapy or radiation therapy.Median survival of resected patients with hepatic metastases has been reported to range from 6-12 months, and for patients with single metastases is reported to range from 4.5-6.2 months to 11 and 21 months [16,22,25,27].The benefits of surgical therapy have been emphasized by different experience, with a 5-year overall survival rate ranging from 2MO%. In a recent multicenter survey a 33% 5-year survival rate was demonstrated in 859 patients resected for hepatic metastases.

Surgical treatment for metastatic malignancies. Anatomical resection of liver metastasis: indications and outcomes

“…The prognosis of synchronous liver metastasis has been reported by several investigators 5,[9][10]22,41,68,69,96,102,103,109,110,[123][124][125][126][127] as being worse than that of metachronous metastasis, while several others postulate that clinical stage 4,10,16,27,41,61,76,83,86,87,90,96,103,123,126,[128][129][130] or lymph node metastasis 8,23,38,40,41,80,86,89,90,96,118,[131][132][133][134][135]...…”

Treatment strategy for multiple hepatic metastases of colorectal carcinoma

“…It is arguable whether there is a significant difference in survival rate after hepatic resection between patients with solitary metastasis and those with multiple lesions (Table 1). However, a general consensus appears to have been reached that, in patients with four or more metastases, there is an association between the number of metastases and survival, although the results in individual reports vary: Iwatsuki et al11 reported that none of the seven patients with four or more lesions in their series of 60 patients with hepatic resections survived for more than 3 years, whereas Sheele et al,21 Doci et al,14 and Fegiz et al31 found no such a relationship. Figure 1a,b shows the results of our own experience with 65 patients who had hepatic resections for liver metastasis of colorectal cancer.…”

Kurative und diagnostische Resektionen an der Leber

“…Insgesamt [24,25]. Nach internationalen Daten entwickeln mehr als 50% der Patienten mit einem Kolonkarzinom Lebermetastasen als alleinige Lokalisation oder mit anderen Metastasenlokalisationen [2,4,8]. Hier sind unsere Daten deutlich niedriger (29,2%); dies ist durch die durchschnittliche Nachbeobachtungszeit von 28,4 Monaten zu erklären.…”

“…25% der Patienten, die an einem kolorektalen Karzinom erkranken, soll sich eine isolierte Lebermetastasierung mit der Möglichkeit einer Resektabilität entwickeln [2,8]. Andere Autoren sehen den Anteil von Patienten mit potenziell resektablen Metastasen allerdings geringer [14,19].…”