title: Aggressive liver resection including major-vessel resection for colorectal liver metastases.
abstract: OBJECTIVE
  To clarify short- and long-term outcomes of combined resection of liver with major vessels in treating colorectal liver metastases.
  
  
  METHODS
  Clinicopathologic data were evaluated for 312 patients who underwent 371 liver resections for metastases from colorectal cancer. Twenty-five patients who underwent resection and reconstruction of retrohepatic vena cava, major hepatic veins, or hepatic venous confluence during hepatectomies were compared with other patients, who underwent conventional liver resections.
  
  
  RESULTS
  Morbidity was 20% (75/371) and mortality was 0.3% (1/312) in all patients after hepatectomy. Hepatic resection combined with major-vessel resection/reconstruction could be performed with acceptable morbidity (16%) and no mortality. By multivariate analysis, repeat liver resection (relative risk or RR, 5.690; P = 0.0008) was independently associated with resection/reconstruction of major vessels during hepatectomy, as were tumor size exceeding 30 mm (RR, 3.338; P = 0.0292) and prehepatectomy chemotherapy (RR, 3.485; P = 0.0083). When 312 patients who underwent a first liver resection for initial liver metastases were divided into those with conventional resection (n = 296) and those with combined resection of liver and major vessels (n = 16), overall survival and disease-free rates were significantly poorer in the combined resection group than in the conventional resection group (P = 0.02 and P < 0.01, respectively). A similar tendency concerning overall survival was observed for conventional resection (n = 37) vs major-vessel resection combined with liver resection (n = 7) performed as a second resection following liver recurrences (P = 0.09). Combined major-vessel resection at first hepatectomy (not performed; 0.512; P = 0.0394) and histologic major-vessel invasion at a second hepatectomy (negative; 0.057; P = 0.0005) were identified as independent factors affecting survival by multivariate analysis.
  
  
  CONCLUSIONS
  Hepatic resection including major-vessel resection/reconstruction for colorectal liver metastases can be performed with acceptable operative risk. However, such aggressive approaches are beneficial mainly in patients responding to effective prehepatectomy chemotherapy.
authors.affiliation: Kuniya Tanaka, Ryusei Matsuyama, Kazuhisa Takeda, Kenichi Matsuo, Yasuhiko Nagano, Itaru Endo, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Ryusei
authors.initials: R
authors.lastname: Matsuyama
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takeda
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo