Role of hepatectomy in treating multiple bilobar colorectal cancer metastases.
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.
Tanaka
Kuniya
K
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Shimada
Hiroshi
H
Ueda
Michio
M
Matsuo
Kenichi
K
Endo
Itaru
I
Togo
Shinji
S
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