Hepatic resection for colorectal liver metastases.
Colorectal liver metastases are a frequent and lethal complication of cancer. Hepatic resection is an effective treatment for patients with colorectal liver metastases and can provide a 25 to 35 per cent 5-year survival rate. All potential resection candidates should undergo extensive preoperative testing to exclude extrahepatic metastases and local recurrence. Contraindications to resection are the presence of (1) positive portal/celiac lymph nodes, (2) extrahepatic discontiguous disease, and (3) four or more lesions. At surgery all patients should undergo a detailed examination of the lymph nodes (periportal, retroperitoneal, regional), peritoneal surfaces, and the liver. Every resection candidate should have an intraoperative ultrasound examination of the liver. This modality will identify the presence of small, nonpalpable lesions and define the tumor-vessel relationship. Many types of resections can be performed and are classified as anatomic or nonanatomic (segmental). Preference should be given to segmental resections, because these procedures reduce blood loss, shorten operating time, and lower morbidity and mortality. Unfortunately, not all patients undergoing resection will be cured of the disease; many will develop extrahepatic disease. Effective systemic chemotherapy is necessary to improve survival in patients with colorectal cancer.
Roh
M S
MS
Department of General Surgery, University of Texas M. D. Anderson Cancer Center, Houston.
D015179:Colorectal Neoplasms / Q000473:pathology*; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D014463:Ultrasonography