title: Role of hepatectomy in treating multiple bilobar colorectal cancer metastases.
abstract: BACKGROUND
  Although retrospective studies have demonstrated survival benefit from hepatectomy for metastatic colorectal cancer, few studies have examined patients with multiple bilobar metastases to identify survival-related factors throughout their course.
  
  
  METHODS
  Among 277 patients with R0 resection for liver metastases from colorectal cancer, 79 patients had 4 or more lesions in a bilobar distribution. To determine impact on long-term outcome, we compared clinicopathologic factors retrospectively between 3-year survivors and patients who died less than 3 years after hepatectomy.
  
  
  RESULTS
  Among 79 patients with 4 or more bilobar metastases, 5 patients (6.3%) attained prolonged remission after initial hepatectomy. By multivariate analysis, a lack of adjuvant chemotherapy compromised survival (relative risk or RR, 2.21; P = .036), as did prehepatectomy carcinoembryonic antigen exceeding 12 ng/mL (RR, 2.12; P = .039). Treatment-related variables such as repeat resections in the event of liver recurrence (P < .01) or lung metastases (P < .05), as well as adjuvant chemotherapy (P < .01), differed significantly between 3-year survivors and nonsurvivors, as did the differences in number of metastases, maximum size of metastases, concomitant extrahepatic metastases at the time of initial hepatectomy, and disease-free interval preceding initial recurrence.
  
  
  CONCLUSIONS
  Although not effective as a sole treatment for multiple hepatic metastases of colorectal cancer, liver resection is important in multimodal therapy. Reoperations for recurrence of metastases, followed by additional chemotherapy, frequently obtained long survival.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Michio
authors.initials: M
authors.lastname: Ueda
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors