Liver resection for colorectal metastases in presence of extrahepatic disease: results from an international multi-institutional analysis.
BACKGROUND
Hepatic resection for colorectal liver metastasis (CLM) with concomitant extrahepatic disease (EHD) is a controversial topic. We sought to evaluate the long-term outcome of patients undergoing liver resection for CLM in presence of EHD and identify factors associated with prognosis.


METHODS
From 1996 to 2007, a total of 1629 patients who underwent resection of CLM were identified from an international multi-institutional database. One hundred seventy-one patients (10.4%) underwent resection of EHD. Clinicopathologic and outcome data were collected and analyzed by univariate and multivariate analyses.


RESULTS
Median number of treated CLM was 2 (range, 1-18); most patients had solitary EHD (n = 114; 66.6%) a single anatomic site of EHD (n = 153; 89.4%). The 5-year survival for patients with EHD was 26% compared with 58% for those without EHD (P < 0.001). Recurrence was common (84%). Among patients with EHD, R1 margin status, multiple EHD sites, and location of EHD were associated with worse survival (all P < 0.05). Patients with multiple EHD sites or aortocaval lymph node metastasis had a 5-year survival of 14% and 7%, respectively. When survival was stratified by the total number of metastases treated, the presence of EHD still had a prognostic impact, but the relative impact of EHD diminished as the total number of metastases treated increased.


CONCLUSIONS
Concurrent resection of hepatic and EHD in well-selected patients may provide the possibility of long-term survival. The risk of recurrence, however, remains high, and a worse outcome is associated with both number of metastases and location of EHD.
Department of Clinical and Surgical Sciences, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK.
Carlo
C
Pulitanò
Martin
M
Bodingbauer
Luca
L
Aldrighetti
Mechteld C
MC
de Jong
Federico
F
Castillo
Richard D
RD
Schulick
Rowan W
RW
Parks
Michael A
MA
Choti
Stephen J
SJ
Wigmore
Thomas
T
Gruenberger
Timothy M
TM
Pawlik
D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007390:International Agencies; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate