title: Rational surgical aggression in multimodal treatment of liver colorectal metastases.
abstract: OBJECTIVE
  The purpose of this study was to analyze the influence of aggressive surgery regarding resection of liver metastases (LM) from colorectal cancer (CRC) on morbidity, mortality and survival rates and to establish utility of multimodal strategies increasing resectability rates of liver metastases.
  
  
  METHODS
  Two hundred twenty eight consecutive patients with CRC LMs operated from January 2004 to October 2009 were presented. They underwent 137 curative liver resections. We have used extended criteria for respectability including the possibility to spare 2 adjacent liver segments. Multimodal approaches meaning transformation of primary unresectable LMs to resectable ones were used in 46 cases. During the final decision intraoperative ultrasonography took an important part.
  
  
  RESULTS
  The resectability in presented series was 46% for synchronous LM and 76% for metachronous. Aggressive surgical approach was applied in 75 patients. The average rate of intraoperative hemorrhage was 300mL. Postoperative complications occurred in 25.5% of patients. Two patients died postoperatively.
  
  
  CONCLUSIONS
  Rational surgical behavior in context of multimodal approach to LMs of CRC can increase chances of resectability and long-term survival without influencing morbidity and mortality.
authors.affiliation: Military Medical Academy, Sofia, Bulgaria. nvladov@yahoo.com
authors.forename: Nikola
authors.initials: N
authors.lastname: Vladov
authors.forename: Ivan
authors.initials: I
authors.lastname: Vasilevski
authors.forename: Ivelin
authors.initials: I
authors.lastname: Takorov
authors.forename: Ventzislav
authors.initials: V
authors.lastname: Mutafchiyski
authors.forename: Sergei
authors.initials: S
authors.lastname: Sergeev
authors.forename: Evelina
authors.initials: E
authors.lastname: Odiseeva
authors.forename: Krum
authors.initials: K
authors.lastname: Katzarov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002031:Bulgaria; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional