Hepatic resection for metastatic colon and rectal cancer. An evaluation of preoperative and postoperative factors.
Hepatic resection for metastatic colorectal cancer has been reported in over 700 patients. However, approximately 5000 patients each year are candidates for surgical excision. Since 1972, 25 patients have undergone hepatic resection for colorectal metastases at New York University. Potentially curable synchronous lesions were detected by preoperative liver chemistries and operative palpation. Patients were screened for metachronous lesions by serial liver chemistries and carcinoembryonic antigen (CEA) determinations; when clinical findings or laboratory findings were either positive or equivocal, then scanning techniques were used. Most patients had solitary lesions (20). Thirteen of 25 lesions were synchronous; 12 were metachronous. Anatomic lobectomy was performed in 13 patients (6 extended resections); and wedge resection was performed in 12. The operative mortality rate was four per cent; the 2-year survival rate, 65%; the 5-year survival rate, 25%. Hypertonic dextrose solutions were administered during and after operation. Post-operative albumin requirements ranged from 200 to 300 grams/day. Coagulation factors II, V, VII, and fibrinogen decreased after surgery to 30 to 50% of their preoperative levels. Subsequent elevation of these factors correlated with increased bile production and improvement in liver chemistries 10 to 14 days after operation. At present, hepatic resection for colorectal metastases provides the only potential method of salvage, offering a 20 to 25% long-term survival rate.
D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000032:analysis; D003110:Colonic Neoplasms; D005165:Factor V / Q000032:analysis; D005167:Factor VII / Q000032:analysis; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011182:Postoperative Care; D011183:Postoperative Complications; D011516:Prothrombin / Q000032:analysis; D011517:Prothrombin Time; D012004:Rectal Neoplasms; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors
D002272:Carcinoembryonic Antigen; D012709:Serum Albumin; D005165:Factor V; D005167:Factor VII; D011516:Prothrombin; D005340:Fibrinogen; D001663:Bilirubin