title: Prognostic influence of multiple hepatic metastases from colorectal cancer.
abstract: OBJECTIVE
  The aim of this study was to report the results of surgery for multiple colorectal liver metastases on patient outcome.
  
  
  METHODS
  This was a review of 484 consecutive patients who underwent liver resection for colorectal liver metastases between 1993 and 2003. The cohort was divided into 2 groups, those with 1-3 metastases and those with "multiple" metastases, namely 4 or more lesions. The later group was subdivided into those with less than 8 ("several") or 8 or more ("numerous") separate lesions.
  
  
  METHODS
  the post-operative hospital stay was calculated and morbidity and mortality were assessed.
  
  
  RESULTS
  On multivariate analysis the presence of multiple metastases was the only predictor for both poorer overall survival (p=0.007) and disease-free survival (p=0.031). However, when patients with multiple metastases are analysed in detail this survival disadvantage appears to be only present in patients with numerous (8 or more) lesions.
  
  
  CONCLUSIONS
  Although patients with multiple metastases appear to have a poorer outcome, significant number of patients with multiple metastases survive to 5 years or more and should not be denied surgery. Patients with numerous (8 or more) metastases showed a poorer survival disadvantage. These patients need alternative treatment speculatives.
authors.affiliation: HPB and Transplant Unit, St. James's University Hospital, Leeds LS9 7TF, UK.
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
authors.forename: Z Z R
authors.initials: ZZ
authors.lastname: Hamady
authors.forename: R
authors.initials: R
authors.lastname: Adair
authors.forename: R
authors.initials: R
authors.lastname: Finch
authors.forename: A
authors.initials: A
authors.lastname: Al-Mukhtar
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome