Abstract
In this review of a collected series of patients undergoing hepatic resection for colorectal metastases, 100 patients were found to have survived greater than five years from the time of resection. Of these 100 long-term survivors, 71 remain disease-free through the last follow-up, 19 recurred prior to five years, and ten recurred after five years. Patient characteristics that may have contributed to survival were examined. Procedures performed included five trisegmentectomies, 32 lobectomies, 16 left lateral segmentectomies, and 45 wedge resections. The margin of resection was recorded in 27 patients, one of whom had a positive margin, nine of whom had a less than or equal to 1-cm margin, and 17 of whom had a greater than 1-cm margin. Eighty-one patients had a solitary metastasis to the liver, 11 patients had two metastases, one patient had three metastases, and four patients had four metastases. Thirty patients had Stage C primary carcinoma, 40 had Stage B primary carcinoma, and one had Stage A primarycarcinoma. The disease-free interval from the time of colon resection to the time of liver resection was less than one year in 65 patients, and greater than one year in 34 patients. Three patients had bilobar metastases. Four of the patients had extrahepatic disease resected simultaneously with the liver resection. Though several contraindications to hepatic resection have been proposed in the past, five-year survival has been found in patients with extrahepatic disease resected simultaneously, patients with bilobar metastases, patients with multiple metastases, and patients with positive margins. Five-year disease-free survivors are also present in each of these subsets. It is concluded that five-year survival is possible in the presence of reported contraindications to resection, and therefore that the decision to resect the liver must be individualized.
Similar content being viewed by others
References
Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. Surgery 1986;100:278–84.
Petrelli NJ, Nambisan RN, Herrera L, Mittelman A. Hepatic resection for isolated metastasis from colorectal carcinoma. Am J Surg 1985;149:205–9.
Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup DM. Resection of hepatic metastases from colorectal cancer. Arch Surg 1984;119:647–51.
August DA, Sugarbaker PH, Ottow RT, Gianola FJ, Schneider PD. Hepatic resection of colorectal metastases: influence of clinical factors and adjuvant intraperitoneal 5-FU via Tenckhoff catheter. Ann Surg 1985;201:210–8.
Cady B, McDermott WV. Major hepatic resection for metachronous metastases from colon cancer. Ann Surg 1985;201:204–9.
Fortner JG, Silva JS, Golbey RB, Cox EB, Maclean BJ. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. Ann Surg 1984;199:306–16.
Kambouris AA. The role of major hepatic resections for liver metastases from colorectal cancer. Henry Ford Hosp Med J 1983;31:25–9.
Baden H, Anderson B. Survival of patients with untreated liver metastases from colorectal cancer. Scand J Gastroenterol 1975; 10:221–3.
Wood CB, Gillis CR, Blumgart LH. A retrospective study of the natural history of patients with liver metastases from colorectal cancer. Clin Oncol 1976;2:285–8.
Lahr CJ, Scong S-J, Cloud G, Smith JW, Urist MM, Balch CM. A multifactoral analysis of prognostic factors in patients with liver metastases from colorectal carcinoma. J Clin Oncol 1983;1:720–6.
Bacon HE, Martin PV. The rationale of palliative resection for primary cancer of the colon and rectum complicated by liver and lung metastasis. Dis Colon Rectum 1964;7:211–7.
Stearns MW, Binkley GE. Palliative surgery for cancer of the rectum and colon. Cancer 1954;7:1016–9.
Wagner JS, Adson MA, van Heerden JA, Adson MH, Ilstrup DW. The natural history of hepatic metastases from colorectal cancer. Ann Surg 1984;199:502–8.
Cady B, Monson DO, Swinton NW. Survival of patients after colonic resection for carcinoma with simultaneous liver metastases. Surg Gynecol Obstet 1970;131:697–700.
Attiyeh FF, Wanebo HJ, Stearns MW. Hepatic resection for metastasis from colorectal cancer. Dis Colon Rectum 1978;21:160–2.
O'Connell MJ, Adson MA, Schutt AJ, Rubin J, Moertel CG, Ilstrup DM. Clinical trial of adjuvant chemotherapy after surgical resection of colorectal cancer metastatic to the liver. Mayo Clin Proc 1985;60:517–20.
Oxley EM, Ellis H. Prognosis of carcinoma of the large bowel in the presence of liver metastases. Br J Surg 1969;56:149–52.
Jaffe BM, Donegan WL, Watson F, Spratt JS. Factors influencing survival in patients with untreated hepatic metastases. Surg Gynecol Obstet 1968;127:1–11.
Levine AW, Donegan L, Irwin M. Adenocarcinoma of the colon with fifteen year survival. JAMA 247:2809–10.
Author information
Authors and Affiliations
Additional information
John Radcliffe Infirmary, Oxford, England
Read at the meeting of the American Society of Colon and Rectal Surgeons, Washington, D.C., April 5 to 10, 1987.
Supported in part by Cooper Laser Sonics, Inc.
About this article
Cite this article
Hughes, K.S., Rosenstein, R.B., Songhorabodi, S. et al. Resection of the liver for colorectal carcinoma metastases. Dis Colon Rectum 31, 1–4 (1988). https://doi.org/10.1007/BF02552560
Issue Date:
DOI: https://doi.org/10.1007/BF02552560