title: Hepatectomy for colorectal liver metastases with macroscopic intrabiliary tumor growth.
abstract: OBJECTIVE
  We set out to clarify the clinicopathologic characteristics of colorectal liver metastases with macroscopic intrabiliary tumor growth and to determine optimal surgical management.
  
  
  METHODS
  Over 15 years, 6 of 103 patients undergoing hepatectomy for colorectal liver metastases had macroscopic intrabiliary tumor growth and were analyzed retrospectively.
  
  
  RESULTS
  We performed 11 operations for the 6 patients, consisting of 10 hepatectomies (including 1 hepatopancreatoduodenectomy) and 1 pancreatoduodenectomy. Three patients survived more than 5 years: 1 died of pulmonary emphysema with no sign of recurrence 101 months after initial hepatectomy; the 2 others were alive with no sign of recurrence at 74 and 145 months after initial hepatectomy. Median survival time of all 6 patients was 87.5 months. Histologically, intrabiliary tumor growth had two components: intraluminal and intraepithelial extension. In the proximal direction, distance between these two components ranged from 4-10 mm.
  
  
  CONCLUSIONS
  Aggressive surgical treatment can improve chances of long-term survival for patients with macroscopic intrabiliary growth of colorectal liver metastasis. Although nonanatomic limited resection is a common procedure for colorectal liver metastasis, anatomic hepatobiliary resection is recommended.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Teiichi
authors.initials: T
authors.lastname: Sugiura
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Koji
authors.initials: K
authors.lastname: Oda
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.forename: Hideki
authors.initials: H
authors.lastname: Nishio
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Arai
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome