Selective resection of colorectal liver metastases.
OBJECTIVE
Safety of liver surgery for colorectal cancer liver metastases after neoadjuvant chemotherapy has to be re-evaluated.


METHODS
Two hundred Patients were prospectively analyzed after surgery for colorectal cancer liver metastases between 2001 and 2004 at our institution. Special emphasis was given to perioperative morbidity and mortality under modern perioperative care.


RESULTS
There was no in-hospital mortality and the perioperative morbidity was 10% (20/200). Four patients had to be reoperated due to bile leak or intraabdominal abscess. The remainder either had infectious complications or pleural effusion and/or ascites requiring tapping. Variables strongly associated with decreased survival were T, N, G and UICC (International Union against cancer) classification of the primary, hepatic lesions>5 cm and elevated tumour markers. Short disease free interval and neoadjuvant chemotherapy without response predicted impaired recurrence free survival (RFS). Multivariate analysis revealed lymph node status and differentiation of the primary, presence of extrahepatic tumour and gender as factors associated with decreased survival. Administration of neoadjuvant chemotherapy was not associated with higher postoperative morbidity or prolonged hospital stay.


CONCLUSIONS
Modern dissection techniques and improved perioperative care contributed to a very low rate of surgery-related morbidity (10%) and a zero percent mortality which was also observed in patients pretreated with neoadjuvant chemotherapy prior to resection. Liver resection in experienced hands has become a safe part in the potentially curative attempt of treating patients with metastatic colorectal cancer.
Tamandl
D
D
Department of Surgery, Hepatobiliary Service, Vienna Medical University, Währinger Gürtel 18-20, 1090 Vienna, Austria. dietmar.tamandl@meduniwien.ac.at
Gruenberger
B
B
Herberger
B
B
Schoppmann
S
S
Bodingbauer
M
M
Schindl
M
M
Puhalla
H
H
Fleischmann
E
E
Schima
W
W
Jakesz
R
R
Laengle
F
F
Gruenberger
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001317:Austria / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents