title: Strategy for synchronous and multiple liver metastasis.
abstract: OBJECTIVE
  Surgical indications for resection of synchronous metastasis from colorectal cancer (CRC) and the optimal timing of hepatectomy are still controversial and widely debated.
  
  
  METHODS
  Synchronous and multiple metastatic liver tumors were detected in 57 patients since May 2005. Our treatment policy was to perform hepatectomy if the resection could be done with no limit on size and number of tumors. However, if curative resection could not be done, chemotherapy was begun and timing for the possibility of a radical operation was planned immediately.
  
  
  RESULTS
  In 37 patients whose tumors were located only in the liver, primary tumor resection was performed in 16 patients and after tumor-decreasing by chemotherapy, in 7 patients. In 20 patients in whom chemotherapy was performed first, after controlling the distant metastasis, hepatectomy was performed in 3 patients and staged hepatectomy was performed in 10. Recurrence was detected after hepatectomy in 75.0% of simultaneous resection cases and in 70.0% of staged cases. In the recurrence cases, early detection after tumor resection occurred in 58.3% of the simultaneous and 14.2% of the staged.
  
  
  CONCLUSIONS
  The present data show that neoadjuvant chemotherapy does not increase the risk of postoperative complications or the surgical difficulties of hepatectomy for colorectal metastases.
authors.affiliation: Gifu University School of Medicine, Gifu, Japan. sting@gifu-u.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Osada
authors.forename: Hisashi
authors.initials: H
authors.lastname: Imai
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuyama
authors.forename: Naoki
authors.initials: N
authors.lastname: Okumura
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nonaka
authors.forename: Takao
authors.initials: T
authors.lastname: Takahashi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin