[Colorectal liver metastases: does the number of metastases determine of resection is oncologically indicated?].
Complete surgical removal of colorectal liver metastases offers the patient the only curative option as long as there is no extrahepatic spread. Apparently the number of parameters of prognostic significance is unlimited. Consequently their importance for the individual prognosis remains questionable. One of the most frequently discussed parameters is the number of lesions in the liver. The aim of this study was therefore to review the literature and to analyze our own patients with colorectal liver metastases. For 302 patients a complete follow-up was available. The patients were grouped according to the number of lesions and the status of resection (R0, R1, R2, Exploration). The groups were compared by Kaplan Meier Analyses with log rank tests. The literature was reviewed until December 1998. The number of metastases was confirmed to be of prognostic value. Three or more metastases made a resection without residual tumor more unlikely than if there were only two or less (17.8% versus 67.2%). 5-year survival after curative resection was reduced in the group with more metastases from 36% to 9% and 10-year survival was reduced from 18% to 0% without reaching statistical significance (p < 0.07). The number of liver metastases may have some prognostic impact for patients after colorectal cancer. However, even if more than four metastases were resected with clear margins some patients did survive for a long time. The most important parameter to predict an oncological benefit is resection without residual tumor. If this is technically and functionally possible the patient should not be denied surgery, his only chance for cure.
Knoefel
W T
WT
Abteilung für Allgemeinchirurgie, Universitäts-Krankenhaus Eppendorf. knoefel@uke.uni-hamburg.de
Brunken
C
C
Neumann
E
E
Gundlach
M
M
Rogiers
X
X
Izbicki
J R
JR
D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome