title: Liver resection for multiple colorectal liver metastases with surgery up-front approach: bi-institutional analysis of 736 consecutive cases.
abstract: BACKGROUND
  Preoperative chemotherapy has become more common in the management of multiple resectable colorectal liver metastases; however, the benefit is unclear. This study examined clinical outcomes following liver resection for multiple colorectal liver metastases with the surgery up-front approach.
  
  
  METHODS
  Data collected prospectively over a 16-year period for 736 patients who underwent hepatic resection at two different centers were reviewed. Patients were divided into three groups depending on the number of tumors as follows: group A, between one and three tumors (n = 493); group B, between four and seven tumors (n = 141); and group C, eight or more tumors (n = 102).
  
  
  RESULTS
  The 5-year overall and recurrence-free survival rates were 51 and 21 %, respectively, for the entire patient cohort, 56 and 29 % in group A, 41 and 12 % in group B, and 33 and 1.7 % in group C. Multivariate analysis showed that decreased survival was associated with positive lymph node metastasis of the primary tumor, the presence of extrahepatic tumors, a maximum liver tumor size >5 cm, and tumor exposure during liver resection.
  
  
  CONCLUSIONS
  In patients with multiple liver metastases, the number of liver metastases has less impact on the prognosis than other prognostic factors. Complete resection with repeat metastasectomy offers a chance of cure even in patients with numerous colorectal liver metastases (i.e., those with eight or more nodules). A further prospective study is necessary to clarify the optimal setting of preoperative chemotherapy.
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo 135-8500, Japan. akio.saiura@jfcr.or.jp
authors.forename: Akio
authors.initials: A
authors.lastname: Saiura
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Rintaro
authors.initials: R
authors.lastname: Koga
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Shojiro
authors.initials: S
authors.lastname: Hata
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome