title: Is hepatic resection for multiple liver metastases from colorectal carcinoma acceptable treatment?
abstract: OBJECTIVE
  To determine an appropriate surgical treatment for patients with multiple liver metastases, we evaluated the efficacy of treatment in patients with 5 or more liver tumors in both lobes after metastasis from colorectal carcinoma which we refer to as H3 liver metastasis.
  
  
  METHODS
  Seventy-two cases of H3 liver metastasis were classified as follows into four types according to tumor distribution in the liver: type A (n = 16), multiple metastases present in one lobe, and, in the other, confined to one segment; type B (n = 12), multiple metastases present bilaterally, but with tumors larger than 2 cm in diameter confined to one lobe or to three segments; type C (n = 10), multiple and diffuse metastases present in both lobes and all tumors 2 cm or less in diameter; and type D (n = 34) metastatic tumors larger than 2 cm in diameter occurring in every segment of the both lobes. Hepatectomy was performed within a possible range as a rule for all cases, and intrahepatic arterial infusion was performed in unresectable cases. In cases that responded to intrahepatic arterial infusion, hepatectomy was considered and performed when technically possible and potentially curative.
  
  
  RESULTS
  The proportion of cases treated with hepatectomy were: type A, 56.3%; type B, 8.3%; type C, 10.0%; and type D, 2.9%. The regional intrahepatic arterial infusion ratios and response rates to it were 18.8% and 0.0% in type A, 91.7% and 33.3% in type B, 80.0% and 71.4% in type C, and 64.7% and 0.0% in type D, respectively. One type B patient whose tumor showed complete resolution after intrahepatic arterial infusion and one type C patient with a partial response underwent hepatectomy. The cumulative survival rate at two years was significantly lower in type D (3.2%), than in the other types (type A, 33.3%; type B, 36.4%; and type C, 11.7%).
  
  
  CONCLUSIONS
  These results suggested that hepatectomy should be performed in cases of type A, and that intrahepatic arterial infusion may be effective as neoadjuvant chemotherapy for type B or C. However, there is no effective treatment for type D at present.
authors.affiliation: Second Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236, Japan. tkuniya@med.yokohama-cu.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: H
authors.initials: H
authors.lastname: Shimada
authors.forename: S
authors.initials: S
authors.lastname: Togo
authors.forename: M
authors.initials: M
authors.lastname: Ota
authors.forename: S
authors.initials: S
authors.lastname: Yamagichi
authors.forename: H
authors.initials: H
authors.lastname: Ike
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate; D016896:Treatment Outcome