title: Combined hepatic and inferior vena cava resection for colorectal metastases.
abstract: Surgical resection continues to offer the only hope for cure of colorectal cancer metastatic to the liver. Tumor involvement of the vena cava is often viewed as a contraindication to surgical resection. Whereas proven technically feasible, the survival advantages of en bloc liver and vena cava resection remain unclear. We reviewed all patients at a tertiary care center who had resection of colorectal liver metastases, including those with vena cava resections. Eleven patients had en bloc liver and vena cava resection between 1988 and 2002; during the same time period, 97 patients underwent isolated liver resection. There were no perioperative deaths in the 11 patients. All resections had negative histological margins. Mean follow-up was 33 months from the date of surgery. Median disease-free survival of the group having caval resections was 9 months, whereas median survival was 34 months. When compared to the cohort of isolated hepatic resections, the group undergoing caval resections experienced a significantly reduced disease-free survival of 18.6 vs. 9.1 months, respectively (P = 0.03); however, there was no difference in overall survival between the two groups at 55.2 vs. 34.3 months, respectively (P = 0.20). Colorectal liver metastases involving the vena cava should be considered for surgical resection.
authors.affiliation: Department of Surgery, Section of Hepatobiliary Surgery, University of Alberta, Walter Mackenzie Health Sciences Centre, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Johnson
authors.forename: Maurice
authors.initials: M
authors.lastname: Blitz
authors.forename: Norman
authors.initials: N
authors.lastname: Kneteman
authors.forename: David
authors.initials: D
authors.lastname: Bigam
mesh_terms: D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000601:surgery*