Resection of the liver for colorectal carcinoma metastases

Abstract

In this review of a collected series of patients undergoing hepatic resection for colorectal metastases, 100 patients were found to have survived greater than five years from the time of resection. Of these 100 long-term survivors, 71 remain disease-free through the last follow-up, 19 recurred prior to five years, and ten recurred after five years. Patient characteristics that may have contributed to survival were examined. Procedures performed included five trisegmentectomies, 32 lobectomies, 16 left lateral segmentectomies, and 45 wedge resections. The margin of resection was recorded in 27 patients, one of whom had a positive margin, nine of whom had a less than or equal to 1-cm margin, and 17 of whom had a greater than 1-cm margin. Eighty-one patients had a solitary metastasis to the liver, 11 patients had two metastases, one patient had three metastases, and four patients had four metastases. Thirty patients had Stage C primary carcinoma, 40 had Stage B primary carcinoma, and one had Stage A primary carcinoma. The disease-free interval from the time of colon resection to the time of liver resection was less than one year in 65 patients, and greater than one year in 34 patients. Three patients had bilobar metastases. Four of the patients had extrahepatic disease resected simultaneously with the liver resection. Though several contraindications to hepatic resection have been proposed in the past, five-year survival has been found in patients with extrahepatic disease resected simultaneously, patients with bilobar metastases, patients with multiple metastases, and patients with positive margins. Five-year disease-free survivors are also present in each of these subsets. It is concluded that five-year survival is possible in the presence of reported contraindications to resection, and therefore that the decision to resect the liver must be individualized.

Tumor recurrence and options for further treatment after resection of liver metastases in patients with colorectal cancer

“…Only 5-17% of the patients had recurrent liver metastases exclusively, and in only 12% of the patients extrahepatic metastases remained the only site of tumor. Single locations as the initial recurrence are reported in up to 59% of the patients, with only 11% having multiple localizations; the proportion of patients, however, developing disseminated recurrences in the further course ex- ceeds 65-75% [6,8,13]. The percentage of local recurrences in our patients (13.5%) is comparable to that reported in other studies with an incidence of 9% and 12% [8,13].…”

“…The studies published to date report recurrence rates of between 30% and 79% [2]. The median recurrence-free interval after liver resection is rather short (only 9 months) which confirms the results of other studies [7,8,13,14]. Only a few investigations [4,7] have mentioned a median recurrencefree interval of up to 14 months; however, no systematic follow-up examinations were carried out in these patients.…”

“…Single locations as the initial recurrence are reported in up to 59% of the patients, with only 11% having multiple localizations; the proportion of patients, however, developing disseminated recurrences in the further course ex- ceeds 65-75% [6,8,13]. The percentage of local recurrences in our patients (13.5%) is comparable to that reported in other studies with an incidence of 9% and 12% [8,13]. It is remarkable that all of our patients and those reported by Hughes [ 131 with a local recurrence as the first site of recurrent tumor always developed further tumor metastases.…”

Genetic and Histological Assessment of Surgical Margins in Resected Liver Metastases From Colorectal Carcinoma

“…15,16 Although many surgeons may try to achieve SMs as wide as possible during hepatic resection for colorectal metastases, there has been no concrete evidence regarding how much margin is necessary for successful hepatectomy. Since the report of Hughes and coworkers, 17 other authors [1][2][3][4][5][17][18][19][20][21][22][23][24] have noted the prognostic significance of the SM after liver resection for metastatic colorectal carcinoma ( Table 6). Among these 14 reports, including the present study, only 4 stated that an SM 10 mm or wider was a favorable prognostic factor.…”

Safe liver resection following chemotherapy for colorectal metastases is a matter of timing

“…Fifty per cent of these patients will either present with or develop liver metastases in the course of their disease (Scheele et al, 1990(Scheele et al, , 1995Sugarbaker, 1990;Stangl et al, 1994). Of these, 20 -30% are suitable for resection, which currently offers the greatest chance of cure, with a 5-year survival after curative liver resection being 25 -40% (Hughes et al, 1986;Stangl et al, 1994;Scheele et al, 1995;Nordlinger et al, 1996;Rees et al, 1997;Fong et al, 1999;Adam et al, 2003).…”