title: Results of surgical treatment for multiple (> or =5 nodules) bi-lobar hepatic metastases from colorectal cancer.
abstract: BACKGROUND
  The surgery for the treatment of multiple (> or =5) bi-lobar hepatic metastases from colorectal cancer is controversial. This retrospective study presents our experience in an attempt to develop reasonable treatment guidelines.
  
  
  METHODS
  One hundred sixty-one consecutive patients who underwent liver resection with curative intent were classified into three groups: H1 (unilateral), H2 (bilateral, < or =4 nodules), or H3 (bilateral, > or =5 nodules).
  
  
  RESULTS
  The overall cumulative 5-year survival rate was 46.7%. Survival was similar among patients with H1, H2, and H3 disease. Thirty-two patients with H3 disease underwent hepatectomy: straightforward hepatectomy in 12, portal vein embolization (PVE) prior to hepatectomy in eight, two-stage hepatectomy in two, and two-stage hepatectomy combined with PVE in ten. Two-stage hepatectomy with or without PVE was the standard approach in patients with synchronous liver metastases. The operating mortality in hepatectomy for H3 disease was 0%, and the morbidity was 15.2%. The overall response rate to neoadjuvant chemotherapy (NAC) was 41.7% (5/12). Patients who responded to NAC (n=5) had a better prognosis than non-responders (n=7) ( P<0.05).
  
  
  CONCLUSIONS
  Extended hepatectomy, including preoperative PVE and multi-step hepatectomy, combined with NAC, may result in a favourable prognosis, especially in patients who respond to NAC, but further studies with more patients are needed to confirm this.
authors.affiliation: Department of Surgery II, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004 Yokohama, Japan. hs440312@med.yokohama-cu.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Masui
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Miyuki
authors.initials: M
authors.lastname: Kijima
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ichikawa
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ike
authors.forename: Shigeo
authors.initials: S
authors.lastname: Ooki
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D020360:Neoadjuvant Therapy / Q000379:methods; D011169:Portal Vein; D011300:Preoperative Care; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents