title: Surgery for multiple hepatic colorectal metastases.
abstract: The purpose of this review is to address three important questions concerning hepatic resection for multiple colorectal metastases. (1) Is the number of tumors truly a significant prognostic factor? (2) Are patients with four or more tumors contraindicated for hepatic resection? (3) Up to how many nodules should we attempt to resect? Although the efficacy of surgical resection for one to three hepatic metastases is clear, based on several reports, the literature regarding the resection of four or more metastatic lesions is conflicting. Review of the data at our institutions showed that the number of tumors was a significant prognostic factor, because patient survival after liver resection for multiple metastases was worse than that for single metastasis. However, patients with two or three nodules and those with four or more nodules showed the same survival curves, or those with four or more metastases fared even better. Therefore, patients with four or more metastases should be considered for hepatic resection. The maximum number of hepatic tumors in longterm survivors reported in the literature has been increasing, and the limit for the number of respectable metastases has not yet been determined. Because liver resection is still the only treatment that offers a cure, surgery for multiple metastases may be justified as long as the operation is safe and technically feasible.
authors.affiliation: Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Seki
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D000075202:Contraindications; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011169:Portal Vein; D011379:Prognosis