Survival After Resection of Multiple Bilobar Hepatic Metastases From Colorectal Carcinoma

Abstract

ObjectiveTo define the long-term outcome and treatment complications for patients undergoing liver resection for multiple, bilobar hepatic metastases from colorectal cancer. MethodsA retrospective analysis of 165 consecutive patients undergoing liver resection for metastatic colorectal cancer was performed. Patients were divided into a simple hepatic metastasis group, consisting of patients with three or fewer metastases in a unilobar distribution, and a complex hepatic metastases group, consisting of patients with four or more unilobar metastases or at least two bilobar metastases. ResultsThe 5-year survival rate was 36% for the simple group and 37% for the complex group. Multivariate analysis revealed that the number of hepatic segments involved by tumor and the maximum diameter of the largest metastasis correlated significantly with the 5-year survival rate. The surgical death rate was 4.9% for the simple group and 9.1% for the complex group; this difference was not significant. Multivariate analysis revealed that extended lobar resection and concomitant colon and hepatic resection were significant and independent predictors of surgical death. The combination of extended lobar resection and concomitant colon resection was used significantly more frequently in the complex group than in the simple group. ConclusionsResection of complex hepatic metastases, as defined in this study, results in a 5-year survival rate of 37% and confers the same survival benefit as does resection of limited hepatic metastases. The surgical death rate for this aggressive approach is significantly higher if extended lobar resections are necessary and if concomitant colorectal resection is performed. Patients who have complex hepatic metastases at the time of diagnosis of the primary colorectal cancer and who would require extended hepatic lobectomy should have hepatic resection delayed for at least 3 months after colon resection.Substantial surgical experience, reported from multiple institutions, 1-5 supports the surgical resection of limited, isolated hepatic metastases from colorectal carcinoma, with 5-year survival rates of 30% or more reported routinely. The majority of the surgical experience reported to date has been in patients with one, two, or three metastatic lesions, usually confined to one lobe of the liver. The suitability for resection of patients with more complex hepatic metastatic disease has not been well defined. The multiinstitutional review reported by Hughes et al 6 of 100 patients surviving 5 years or more after resection of hepatic metastases from colorectal cancer included only three patients with four or more metastatic lesions. Scheele et al, 2 in one of the largest single-institution reports to date, reported experience with only 32 patients undergoing resection of four or more metastatic lesions. Further, reports of resection of multiple metastases are confounded by the classification as multiple lesions of clusters of small lesions in close proximity or of satellite lesions around a large metastasis.Bec...

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