title: Multicentre study of liver metastases from colorectal cancer in pathological livers.
abstract: OBJECTIVE
  Resection of colorectal cancer (CRC) liver metastases (LM) in pathological liver (PL) patients (with cirrhosis or hepatopathy) is extremely rare. The aim of this study was to perform a multicentre, retrospective analysis of epidemiology, surgical techniques and outcomes in patients with PL who underwent hepatic resection for CRC-LM.
  
  
  METHODS
  A retrospective, multicentre questionnaire was distributed to 15 hepatopancreatobiliary surgical units.
  
  
  RESULTS
  Only six of 15 (40%) HPB units reported any experience in the surgical resection of CRC-LM in patients with PL. Of the 20 patients identified, 10 had underlying cirrhosis and 10 had chronic hepatopathy. Their median age was 66 years (range: 49-81 years). Thirteen patients were male. Liver dysfunction was known preoperatively in 18 patients. All patients had Child-Pugh class A disease. Six patients had synchronous disease. There were a total of 38 lesions among the 20 patients, distributed at a median of one lesion per patient (range: 1-4 lesions). The median size of the lesions was 3.0 cm (range: 1.5-9.0 cm). Preoperative median carcinoembryonic antigen (CEA) was 32.3 ng/ml (range: 1-184 ng/ml). The surgical procedures performed included: sub-segmentectomy (n= 12); left lateral sectionectomy (n= 6); segmentectomy (n= 4); radiofrequency ablation (n= 3), and exploratory laparotomy (n= 4). Morbidity occurred in four patients (Clavien grades I [n= 1], II [n= 2] and IVa [n= 1]). Mortality was nil. An R0 resection margin was achieved in 15 of 16 patients. Twelve patients did not receive chemotherapy. In resected patients, 10 presented with relapse. The median disease-free and overall survival periods were 12.2 and 22.3 months, respectively.
  
  
  CONCLUSIONS
  When feasible, liver resection is the best option for CRC-LM in PL patients.
authors.affiliation: Department of Hepatopancreatobiliary (HPB) Surgery, Guadalajara University Hospital, Guadalajara, Spain. jose_ramia@hotmail.com
authors.forename: Jose M
authors.initials: JM
authors.lastname: Ramia
authors.forename: Rafael
authors.initials: R
authors.lastname: López-Andujar
authors.forename: Jaume
authors.initials: J
authors.lastname: Torras
authors.forename: Laia
authors.initials: L
authors.lastname: Falgueras
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Gonzalez
authors.forename: Belinda
authors.initials: B
authors.lastname: Sanchez
authors.forename: Joan
authors.initials: J
authors.lastname: Figueras
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D013030:Spain; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome