title: Procedures of choice for resection of primary and recurrent liver metastases from colorectal cancer.
abstract: Although liver resection offers the only realistic chance of cure for patients with liver metastases from colorectal cancer, no consensus exists as to the procedure of choice for managing these tumors. Data from 193 patients who underwent hepatectomy for liver metastases from colorectal cancer and 26 of 193 patients who underwent repeat hepatectomy for recurrent metastases were collected. The suitability of resection was evaluated retrospectively based on known risk factors for recurrence and patterns of recurrence. On multivariate analysis, a positive surgical margin (SM+) was the only risk factor for recurrence after the initial resection (p < 0.01). SM+ (p < 0.01) and nonanatomic resection (p < 0.05) that was less than a sectionectomy (p < 0.05) were risk factors for recurrence after repeat hepatectomy. Multiple tumors (four or more) was the most common pattern of recurrence after initial hepatectomy, and recurrence close to the line of resection was most common after repeat hepatectomy. Based on tumor doubling times, recurrence after initial hepatectomy seemed to originate from the primary colorectal lesion, whereas recurrence after repeat hepatectomy was derived from a hepatic metastasis. Retrospective analysis suggests that hepatectomy with clear surgical margins is more important than anatomic resection for initial hepatectomy, and at least sectionectomy is necessary for repeat hepatectomy.
authors.affiliation: Department of Surgery II, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004 Yokohama, Japan.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Ohta
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
authors.forename: Shuji
authors.initials: S
authors.lastname: Saitou
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekido
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000556:secondary / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors