title: Practice to extend indication of hepatic resection for colorectal liver metastasis.
abstract: OBJECTIVE
  Recent reports have demonstrated that patients with limited extrahepatic disease and bilobar disease can benefit from aggressive surgical resection in combination with chemotherapy. Therefore, we extended indication of hepatic resection for colorectal liver metastasis (CRLM) since 2004. In this report, we retrospectively assessed changes in our therapeutic strategy for CRLM.
  
  
  METHODS
  The subjects were 67 patients who underwent hepatic resection for CRLM between January 2000 and December 2008. Patients were classified into two groups; early period (2000-2003) and late period(2004-2008). We assessed prognostic factors and change in our hepatic resection policy on operative indication for CRLM in relation to therapeutic outcome.
  
  
  RESULTS
  In multivariate analysis, more than 4 lymph node metastases (p=0.0277) and bilobar disease (p=0.0142) were significant predictors of disease- free survival, while significant predictor of overall survival were more than four lymph node metastases (p=0.0014) and bilobar disease (p=0.0392). Bilobar disease and presence of extrahepatic disease were significantly greater in late period. However, incidence of postoperative complications, disease-free and overall survivals in both periods were comparable.
  
  
  CONCLUSIONS
  Practice to extend indication of hepatic resection for patients with advanced CRLM seems to increase the respectability rate without increasing morbidity and mortality, whenever a macroscopically curative resection with acceptable operative risk was thought possible.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Haruki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Kenei
authors.initials: K
authors.lastname: Furukawa
authors.forename: Shigeki
authors.initials: S
authors.lastname: Wakiyama
authors.forename: Masaichi
authors.initials: M
authors.lastname: Ogawa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D010818:Practice Patterns, Physicians'; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome