title: Impact of the degree of liver resection on survival for patients with multiple liver metastases from colorectal cancer.
abstract: BACKGROUND
  Although the degree of hepatic resection has been found to be a key aspect of tumor stimulation, the differences in clinical outcome between a massive liver resection and a less extensive resection for multiple colorectal metastases have not been well studied. The purpose of this study was to clarify the impact of the extent of liver resection on survival outcome.
  
  
  METHODS
  Clinicopathologic data were available for 85 patients who were surgically treated for four or more liver metastases. Forty-nine patients who underwent a major hepatic resection were compared with patients who underwent minor hepatic resections (n = 36).
  
  
  RESULTS
  As the patients undergoing major resection were more likely to have multiple (p = 0.014) and large tumors (p = 0.021) compared to the minor-resection patients, their overall survival was worse (p = 0.046) and the disease-free rate tended to be poorer. By multivariate analysis of the cohorts, the only independent factor affecting survival was the number of liver tumors (< or =5 or > or =6; relative risk [RR] = 0.427; p = 0.014). When patients with six or more metastases were selected and analyzed, the overall survival of patients who had a major resection was significantly poorer than those who had minor resections (p = 0.028), although the clinical characteristics were comparable between the two groups.
  
  
  CONCLUSIONS
  Although the extent of hepatectomy was not an independent prognosticator, minor resections for multiple colorectal metastases may offer a long-term survival advantage compared to a major resection.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. ktrj112@urahp.yokohama-cu.ac.jp
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Chizuru
authors.initials: C
authors.lastname: Matsumoto
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takeda
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D016896:Treatment Outcome