title: Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect.
abstract: BACKGROUND
  The presence of extrahepatic disease (EHD) is considered a contraindication to hepatectomy in patients with colorectal liver metastases. After resection, the prognosis is based more on the total number of resected metastases (located inside and outside the liver) than on the site of these metastases (only inside the liver or not).
  
  
  METHODS
  A total of 308 patients with colorectal cancer underwent hepatectomy, and 84 (27%) also underwent resection of miscellaneous EHD. The study was a prospective data registration and retrospective analysis. When considering the total number of resected metastases, each liver metastasis and each EHD location was counted as one lesion. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  The median follow-up was 99 months. The overall 5-year survival rate was 32%. In the multivariate analysis, the total number of metastases (inside or outside the liver) had a greater prognostic value than the criterion "presence or absence of EHD." Considering the total number of resected metastases (whatever their site), 5-year survival rates were 38% (SD: 4%) in the group with one to three metastases, 29% (SD: 5%) in patients with four to six metastases, and 18% (SD: 5%) in patients with more than six metastases (P = .002). A very simple prognostic score based on sex and the total number of metastases is proposed.
  
  
  CONCLUSIONS
  EHD, when resectable, is no longer a contraindication to hepatectomy. More importantly, the total number of the metastases, whatever their location, has a stronger prognostic effect than the site of these metastases.
authors.affiliation: Department of Surgical Oncology, Institut Gustave Roussy, Comprehensive Cancer Center, 39 Rue Camille Desmoulins, Villejuif Cédex, 94805, France. elias@igr.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.forename: Gabriel
authors.initials: G
authors.lastname: Liberale
authors.forename: Déwi
authors.initials: D
authors.lastname: Vernerey
authors.forename: Marc
authors.initials: M
authors.lastname: Pocard
authors.forename: Michel
authors.initials: M
authors.lastname: Ducreux
authors.forename: Valérie
authors.initials: V
authors.lastname: Boige
authors.forename: David
authors.initials: D
authors.lastname: Malka
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pignon
authors.forename: Philippe
authors.initials: P
authors.lastname: Lasser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate