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Results of surgical treatment for multiple (≥5 nodules) bi-lobar hepatic metastases from colorectal cancer

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Abstract

Background

The surgery for the treatment of multiple (≥5) bi-lobar hepatic metastases from colorectal cancer is controversial. This retrospective study presents our experience in an attempt to develop reasonable treatment guidelines.

Method

One hundred sixty-one consecutive patients who underwent liver resection with curative intent were classified into three groups: H1 (unilateral), H2 (bilateral, ≤4 nodules), or H3 (bilateral, ≥5 nodules).

Results

The overall cumulative 5-year survival rate was 46.7%. Survival was similar among patients with H1, H2, and H3 disease. Thirty-two patients with H3 disease underwent hepatectomy: straightforward hepatectomy in 12, portal vein embolization (PVE) prior to hepatectomy in eight, two-stage hepatectomy in two, and two-stage hepatectomy combined with PVE in ten. Two-stage hepatectomy with or without PVE was the standard approach in patients with synchronous liver metastases. The operating mortality in hepatectomy for H3 disease was 0%, and the morbidity was 15.2%. The overall response rate to neoadjuvant chemotherapy (NAC) was 41.7% (5/12). Patients who responded to NAC (n=5) had a better prognosis than non-responders (n=7) (P<0.05).

Conclusions

Extended hepatectomy, including preoperative PVE and multi-step hepatectomy, combined with NAC, may result in a favourable prognosis, especially in patients who respond to NAC, but further studies with more patients are needed to confirm this.

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Authors and Affiliations

  1. Department of Surgery II, Yokohama City University School of Medicine, 3–9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan

    Hiroshi Shimada, Kuniya Tanaka, Hidenobu Masui, Yasuhiko Nagano, Kenichi Matsuo, Miyuki Kijima, Yasushi Ichikawa, Hideyuki Ike, Shigeo Ooki & Shinji Togo

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  1. Hiroshi Shimada
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  2. Kuniya Tanaka
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  3. Hidenobu Masui
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  4. Yasuhiko Nagano
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  5. Kenichi Matsuo
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  6. Miyuki Kijima
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  7. Yasushi Ichikawa
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  8. Hideyuki Ike
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  9. Shigeo Ooki
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  10. Shinji Togo
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Correspondence to Hiroshi Shimada.

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Shimada, H., Tanaka, K., Masui, H. et al. Results of surgical treatment for multiple (≥5 nodules) bi-lobar hepatic metastases from colorectal cancer. Langenbecks Arch Surg 389, 114–121 (2004). https://doi.org/10.1007/s00423-003-0447-6

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  • DOI: https://doi.org/10.1007/s00423-003-0447-6

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