title: Effectiveness of surgery in liver metastasis from colorectal cancer: experience and results of a continuous improvement process.
abstract: OBJECTIVE
  The aim of this study was to estimate the effectiveness of surgery in liver metastasis from colorectal cancer.
  
  
  METHODS
  We conducted a prospective and observational study of patients with colorectal liver metastasis operated on at the San Cecilio University Hospital of Granada from March 2003 until June 2013. The primary variables of the result were survival and morbidity before 30 days of the post-operative period. We also measured preoperative and surgical variables.
  
  
  RESULTS
  A total of 147 patients with liver metastasis of colorectal origin underwent surgical removal during the period of study, 38 of whom had repeat surgery. 34 had a second resection, 3 had a third one and one only patient had a fourth one, for a total of 185 registered operations. The global 5-year survival rate was 38 and 17 % after 10 years. There were 115 patients who had neither radiofrequency nor exploratory laparotomy, 38 % of them survived over 60 months. The average disease-free time was 23.6 months ± 47.3, with significant differences observed between types of procedures. Patients that were operated on just once (n = 25) had a five-year actuarial survival rate of 35 %, a morbidity rate of 24 % and a mortality rate of 0.6 % (1 patient only). The average hospital stay was 13.8 days and the disease-free time was 15.8 months.
  
  
  CONCLUSIONS
  The results obtained in our surgical unit in terms of morbidity, mortality and five-year actuarial survival rates are comparable to those of other units at large institutions, which are currently considered the standards of quality.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Granada, Av de Madrid, 11, 18012, Granada, Spain, drnavarrofreire@hotmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Navarro-Freire
authors.forename: P
authors.initials: P
authors.lastname: Navarro-Sánchez
authors.forename: N
authors.initials: N
authors.lastname: García-Agua
authors.forename: B
authors.initials: B
authors.lastname: Pérez-Cabrera
authors.forename: A
authors.initials: A
authors.lastname: Palomeque-Jiménez
authors.forename: J A
authors.initials: JA
authors.lastname: Jiménez-Rios
authors.forename: P A
authors.initials: PA
authors.lastname: García-López
authors.forename: A J
authors.initials: AJ
authors.lastname: García-Ruiz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome