title: Maximal debulking liver resection as a beneficial treatment strategy for advanced and aggressive colorectal liver metastases.
abstract: BACKGROUND
  A survival benefit is generally considered unobtainable following incomplete hepatic resection in patients with colorectal liver metastases. However, this question should be readdressed considering recent chemotherapy, often combining a monoclonal antibody directed against colorectal cancer with various classic and improved strategies. We examined whether a survival benefit could be obtained from maximal reduction surgery for colorectal liver metastases.
  
  
  METHODS
  We retrospectively analyzed data from 165 patients with liver recurrence after hepatectomy for colorectal metastases.
  
  
  RESULTS
  We hypothesized that recurrence soon after surgery, frequently involved metastases left behind during liver resection, resembling the situation after debulking hepatectomy. When patients were divided according to time of liver recurrence, patients with early recurrence had significantly poorer overall survival than those with later recurrence (p<0.01). However, patients with multiple bilobar metastases (n=77), having a greater likelihood of metastases left behind at hepatectomy, had similar survival whether recurrence was early or late (p=0.13). Response to chemotherapy before first hepatectomy was prognostically important (relative risk of 0.107; p=0.02) for patients with early liver recurrence, as were number of recurrent tumors and status of extrahepatic disease.
  
  
  CONCLUSIONS
  Debulking surgery for multiple bilobar metastases may represent a treatment strategy with potential survival benefit, especially when initial metastases respond well to pre-hepatectomy chemotherapy.
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan u17-92ts@med.teikyo-u.ac.jp.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yabushita
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Hiroshima
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Koda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D016896:Treatment Outcome
keywords: Liver metastases; colorectal cancer; debulking surgery