title: Liver metastases from colorectal cancer: present surgical approach.
abstract: 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.
authors.affiliation: Department of Surgery and Transplantation, University of Bologna, S. Orsola Hospital, Bologna, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Cavallari
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Bellusci
authors.forename: Roberto
authors.initials: R
authors.lastname: Montalti
authors.forename: Nicola
authors.initials: N
authors.lastname: De Ruvo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Antonio
authors.initials: A
authors.lastname: De Vivo
authors.forename: Emilio
authors.initials: E
authors.lastname: De Raffele
authors.forename: MariaCristina
authors.initials: M
authors.lastname: Salone
authors.forename: Giuliano
authors.initials: G
authors.lastname: La Barba
mesh_terms: 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