title: Aggressive surgery in the multimodality treatment of liver metastases from colorectal cancer.
abstract: OBJECTIVE
  The purpose of this study was to analyze the impact of aggressive surgery concerning resection of liver metastases (LMs) from colorectal cancer (CRC) on morbidity, mortality and survival rates and to establish the benefits of multimodal strategies in increasing the resectability rates of LMs.
  
  
  METHODS
  From January 2004 - April 2006 184 patients with CRC underwent surgical interventions at our clinic. Thirty-four (18.4%) of them had LMs at the time of initial diagnosis, and 26 patients developed LMs in a certain period of time after resection of the primary CRC. Multimodal therapeutic approach included thermoablation, neoadjuvant chemotherapy and surgery.
  
  
  RESULTS
  44 resections were performed in 29 patients: one-stage resection of the primary CRC and the LMs in 15 (40%) cases, resection and thermoablation after adjuvant chemotherapy in 2 (4.3%), resection after neoadjuvant chemotherapy in 8 (17.2%), two-stage liver resection in 1 (2.15%), resection after recurrence or because of a newfound LM in 3 (6.45%). Five resections of metastases larger than 5 cm, and 4 resections of 4 or more liver metastases were performed. Morbidity rate was 15.9% (bile leakage in 4 patients, liver abscess in 1 and wound disruption in 2). Mortality rate was 2.2% (1 patient).
  
  
  CONCLUSIONS
  Multimodal approach in the treatment of LMs of CRC increases resectability and patient survival and has no influence on morbidity and mortality.
authors.affiliation: Clinic of Hepatobiliary and Pancreatic Surgery, Military Medical Academy, Sofia, Bulgaria. nikbel@abv.bg
authors.forename: N
authors.initials: N
authors.lastname: Belev
authors.forename: I
authors.initials: I
authors.lastname: Takorov
authors.forename: P
authors.initials: P
authors.lastname: Dimov
authors.forename: N
authors.initials: N
authors.lastname: Vladov
authors.forename: V
authors.initials: V
authors.lastname: Penov
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D015996:Survival Rate