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Survival After Resection of Multiple Hepatic Colorectal Metastases

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Abstract

Background: Hepatic resection is potentially curative in selected patients with colorectal metastases. It is a widely held practice that multiple colorectal hepatic metastases are not resected, although outcome after removal of four or more metastases is not well defined.

Methods: Patients with four or more colorectal hepatic metastases who submitted to resection were identified from a prospective database. Number of metastases was determined by serial sectioning of the gross specimen at the time of resection. Demographic data, tumor characteristics, complications, and survival were analyzed.

Results: From August 1985 to September 1998, 155 patients with four or more metastatic tumors (range 4–20) underwent potentially curative resection by extended hepatectomy (39%), lobectomy (42%), or multiple segmental resections (19%). Operative morbidity and mortality were 26% and 1%, respectively. Actuarial 5-year survival was 23% for the entire group (median 5 32 months) and there were 12 actual 5-year survivors. On multivariate analysis, only number of hepatic tumors (P = .005) and the presence of a positive margin (P = .003) were independent predictors of poor survival.

Conclusions: Hepatic resection in patients with four or more colorectal metastases can achieve long-term survival although the results are less favorable as the number of tumors increases. Number of hepatic metastases alone should not be used as a sole contraindication to resection, but it is clear that the majority of patients will not be cured after resection of multiple lesions.

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References

  1. Bengmark S, Hafstrom L. The natural history of primary and secondary malignant tumors of the liver. I. The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy. Cancer 1969;23:198–202.

    PubMed  CAS  Google Scholar 

  2. Ekberg H, Tranberg KG, Andersson R, Lundstedt C, Hagerstrand I, Ranstam J, Bengmark S. Pattern of recurrence in liver resection for colorectal secondaries. World J Surg 1987;11:541–547.

    CAS  PubMed  Google Scholar 

  3. Bozzetti F, Bignami P, Marabito A, Doci R, Gennari L. Patterns of failure following surgical resection of colorectal cancer liver metastases. Ann Surg 1987;205:264–270.

    Article  PubMed  CAS  Google Scholar 

  4. Scheele J, Stangl R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg 1995;19:59–71.

    CAS  PubMed  Google Scholar 

  5. Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Surgery 1986;100:278–284.

    CAS  PubMed  Google Scholar 

  6. Ekberg H, Tranberg K-G, Andersson R, Lundstedt C, Hagerstrand I, Ranstam J, Bengmark S. Determinants of survival in liver resection for colorectal secondaries. Br J Surg 1986;73:727–731.

    PubMed  CAS  Google Scholar 

  7. Doci R, Gennari L, Bignami P, Montalto F, Morabito A, Bozzetti F. One hundred patients with hepatic metastases from colorectal cancer treated by resection: analysis of prognostic determinants. Br J Surg 1991;78:797–801.

    CAS  PubMed  Google Scholar 

  8. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230:309–321.

    Article  CAS  PubMed  Google Scholar 

  9. Melendez JA, Arslan V, Fischer ME, Wuest D, Jarnagin WR, Fong Y, Blumgart LH. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. JACS 1998;187:620–625.

    CAS  Google Scholar 

  10. Billingsley KG, Jarnagin WR, Fong Y, Blumgart LH. Segmentoriented hepatic resection in the management of malignant neoplasms of the liver. JACS 1998;187:471–481.

    CAS  Google Scholar 

  11. Goldsmith NA, Woodburne RT. The surgical anatomy pertaining to liver resection. SGO 1957;105:310–318.

    PubMed  CAS  Google Scholar 

  12. Couinaud C. Bases anatomiques des hepatectomies gauche et droite reglees. J de Chirurgie 1954;70:933–966.

    CAS  Google Scholar 

  13. Schlag P, Hohenberger P, Herfarth C. Resection of the liver metastases in colorectal cancer—competitive analysis of treatment results in synchronous versus metachronous metastases. Eur J Surg Onc 1990;16:360–365.

    CAS  Google Scholar 

  14. Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup DM, van Heerden JA, Adson MA. Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg 1995;222:426–437.

    Article  CAS  PubMed  Google Scholar 

  15. Gayowski TJ, Iwatsuki S, Madariaga JR, Selby R, Todo S, Irish W, Starzl TE. Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. Surgery 1994;116:703–711.

    CAS  PubMed  Google Scholar 

  16. DeMatteo RP, Palese C, Jarnagin WR, Sun RL, Blumgart LH, Fong Y. Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J Gastroint Surg 2000;4:178–184.

    CAS  Google Scholar 

  17. Elias D, Cavalcanti A, Sabourin J-C, Pignonn J-P, Ducreux M, Lasser P. Results of 136 curative hepatectomies with a safety margin of less than 10 mm for colorectal metastases. J Surg Onc 1998;69:88–93.

    CAS  Google Scholar 

  18. Polk W, Fong Y, Karpeh M, Blumgart LH. A technique for the use of cryosurgery to assist hepatic resection. JACS 1995;180:171–176.

    CAS  Google Scholar 

  19. Smith JW, Fortner JG, Burt M. Resection of hepatic and pulmonary metastases from colorectal cancer. Surg Onc 1992;1:399–404.

    CAS  Google Scholar 

  20. Robinson BJ, Rice TW, Strong SA, Rybicki LA, Blackstone EH. Is resection of pulmonary and hepatic metastases warranted in patients with colorectal cancer? J Thorac Cardiovasc Surg 1999;117:66–75.

    PubMed  CAS  Google Scholar 

  21. Lehnert T, Knaebel HP, Duck M, Bulzebruck H, Herfarth C. Sequential hepatic and pulmonary resections for metastatic colorectal cancer. Br J Surg 1999;86:241–243.

    PubMed  CAS  Google Scholar 

  22. Grage TB, Vassilopoulos P, Shingleton WW, Jubert AV, Elias EG, Aust JB, Moss SE. Results of a prospective randomized study of hepatic artery infusion with 5-fluorouracil vs. intravenous 5-fluorouacil in patients with hepatic metastases from colorectal cancer: a Central Oncology Group Study. Surgery 1979;86:550–555.

    PubMed  CAS  Google Scholar 

  23. Baker LH, Talley RW, Maiter R, et al. Phase III comparison of the treatment of advanced gastrointestinal cancer with bolus weekly 5-FU vs. methyl CCNU plus bolus weekly 5-FU. Cancer 1976;38:1–7.

    PubMed  CAS  Google Scholar 

  24. Macdonald JS, Kisner DF, Smythe T, Woolley PV, Smith L Jr, Schein PS. 5-fluorouracil, methyl-CCNU, and vincristine in the treatment of advanced colorectal cancer: phase II study utilizing weekly 5-FU. Cancer Treat Rep 1976;60:1597–1600.

    PubMed  CAS  Google Scholar 

  25. Buroker T, Kim PN, Groppe C, et al. 5FU infusion with mitomycin- C versus 5FU infusion with methyl-CCNU in the treatment of advanced colorectal cancer. Cancer 1978;42:1228–1233.

    PubMed  CAS  Google Scholar 

  26. Meta-analysis group in cancer: reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. J Natl Cancer Inst 1996;88:252–258.

    Google Scholar 

  27. Kemeny N, Conti J, Cohen A, et al. A Phase II study of hepatic arterial FUDR, leucovorin, and dexamethasone for unresectable liver metastases from colorectal carcinoma. J Clin Oncol 1994;12:2288–2295.

    PubMed  CAS  Google Scholar 

  28. Kemeny N, Seiter K, Conti JA, et al. Hepatic arterial floxuridine and leucovorin for unresectable liver metastases from colorectal carcinoma. Cancer 1994;73:1134–1142.

    CAS  PubMed  Google Scholar 

  29. Weaver ML, Atkinson D, Zemel R. Hepatic cryosurgery in treating colorectal metastases. Cancer 1995;76:210–214.

    PubMed  CAS  Google Scholar 

  30. Adam R, Akpinar E, John M, Kunstlinger F, Majno P, Bismuth H. Place of cryosurgery in the treatment of malignant liver tumors. Ann Surg 1997;225:39–50.

    PubMed  CAS  Google Scholar 

  31. Curley SA, Izzo F, Delrio P, et al. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies; results in 123 patients. Ann Surg 1999;230:1–8.

    Article  CAS  PubMed  Google Scholar 

  32. Hewitt PM, Dwerryhouse SH, Zhao J, Morris DL. Multiple bilobar liver metastases: cryotherapy for residual lesions after liver resection. J Surg Oncol 1998;170:1015–1022.

    Google Scholar 

  33. Kemeny N, Huang Y, Cohen A, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 1999;341:2039–2048.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hepatobiliary Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021

    Sharon M. Weber MD, William R. Jarnagin MD, Ronald P. DeMatteo MD, Leslie H. Blumgart MD & Yuman Fong MD

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  1. Sharon M. Weber MD
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  2. William R. Jarnagin MD
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  3. Ronald P. DeMatteo MD
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  4. Leslie H. Blumgart MD
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  5. Yuman Fong MD
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Correspondence to Yuman Fong MD.

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Weber, S.M., Jarnagin, W.R., DeMatteo, R.P. et al. Survival After Resection of Multiple Hepatic Colorectal Metastases. Ann Surg Oncol 7, 643–650 (2000). https://doi.org/10.1007/s10434-000-0643-3

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  • DOI: https://doi.org/10.1007/s10434-000-0643-3

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