Liver metastases from colorectal cancer: present surgical approach.
OBJECTIVE
New developments in surgical techniques and strategies are modifying the indications to resection of liver metastases.


METHODS
From January 1986 to December 2000, 246 consecutive patients with colorectal liver metastases underwent curative hepatic resection. Surgical strategies included simultaneous resection of primary and metastatic colorectal tumor, re-resection of colorectal liver recurrences, two-stage resection and resection of the inferior vena cava when involved by the tumor. Disease-free survival in relation to clinical, pathological and surgical factors was retrospectively assessed with univariate and multivariate analyses.


RESULTS
The overall operative mortality was 0.8%. The 1-, 3- and 5-year disease-free survival rates were 75%, 47% and 40%, respectively. Tumors larger than 7 centimeters, multiple lesions, tumors involving more than 2 segments and those requiring major hepatectomy had a worse prognosis at univariate analysis. A size of the tumor above 7 centimeters was the only independent prognostic factors at multivariate analysis. Two-stage and inferior vena cava resection increased operability; re-resection of recurrent colorectal secondaries prolonged survival.


CONCLUSIONS
Resection of colorectal liver metastases is safe and effective; it should be considered the treatment of choice for this disease and proposed even for advanced lesions. Counseling of the hepatobilary surgeon should be asked for once a liver secondary is detected in the preoperative work-up of a colorectal cancer.
Cavallari
Antonino
A
Department of Surgery and Transplantation, University of Bologna, S. Orsola Hospital, Bologna, Italy.
Vivarelli
Marco
M
Bellusci
Roberto
R
Montalti
Roberto
R
De Ruvo
Nicola
N
Cucchetti
Alessandro
A
De Vivo
Antonio
A
De Raffele
Emilio
E
Salone
MariaCristina
M
La Barba
Giuliano
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate