title: Surgical treatment for extrahepatic recurrence after hepatectomy for colorectal metastases.
abstract: OBJECTIVE
  Recurrence of the remnant liver or extrahepatic sites after hepatic resection for colorectal metastases is concerned as a significant prognostic factor. While regional chemotherapy may reduce recurrence of the liver, appropriate therapy for extrahepatic metastases needs to be elucidated.
  
  
  METHODS
  We identified 207 patients undergoing hepatectomy for colorectal metastases. Patient characteristics, clinicopathological features, sites of extrahepatic recurrence, and outcome are examined.
  
  
  RESULTS
  Recurrence of the lung, brain, bone, and other site after hepatic resection was seen in 49, 8, 8, and 12 cases, respectively. Fourteen patients underwent pulmonary resection, and three patients are alive and disease-free survival was 35, 79, and 128 months after the second resection. Overall 2- and 5-year survival was 64 and 18%. Univariate and multivariate analysis indicated that time and number of pulmonary metastases, and serum CEA levels are independent prognostic factors. Surgical resection for brain metastasis was only in one case who survived for 31 months. Other treatment such as gamma-knife may not improve outcome.
  
  
  CONCLUSIONS
  Both hepatic and pulmonary resection for colorectal metastases could prolong survival in selected patients. Surgical indication for other extrahepatic metastases must be strictly selected, although resection of brain metastasis might lead to better outcome.
authors.affiliation: Department of General Surgery, Chiba University Graduate School of Medicine, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshidome
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Fumio
authors.initials: F
authors.lastname: Kimura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ambiru
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Akira
authors.initials: A
authors.lastname: Togawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nukui
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016001:Confidence Intervals; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis