Objective: To evaluate retrospectively the long-term results of an approach consisting of performing surgery in every patient in whom radical removal of all metastatic disease was technically feasible.
Summary Background Data: The indications for surgical resection for liver metastases from colorectal cancer remain controversial. Several clinical risk factors have been reported to influence survival.
Methods: Between March 1980 and December 1997, 235 patients underwent hepatic resection for metastatic colorectal cancer. Survival rates and disease-free survival as a function of clinical and pathologic determinants were examined retrospectively with univariate and multivariate analyses.
Results: The overall 3-, 5-, 10-, and 15-year survival rates were 51%, 38%, 26%, and 24%, respectively. The stage of the primary tumor, lymph node metastasis, and multiple nodules were significantly associated with a poor prognosis in both univariate and multivariate analyses. Disease-free survival was significantly influenced by lymph node metastasis, a short interval between treatment of the primary and metastatic tumors, and a high preoperative level of carcinoembryonic antigen. The 10-year survival rate of patients with four or more nodules (29%) was better than that of patients with two or three nodules (16%), and similar to that of patients with a solitary lesion (32%).
Conclusions: Surgical resection is useful for treating liver metastases from colorectal cancer. Although multiple metastases significantly impaired the prognosis, the life expectancy of patients with four or more nodules mandates removal.
Although surgical resection is still considered the gold standard in patients with liver metastases from colorectal cancer, its indications are limited and the resectability rate is reported to be only 25%. 1 Moreover, the factors that affect the prognosis remain unclear 2-20 (Table 1), and these uncertain findings, together with the recent spread of interstitial therapies, 21-25 have further reduced the indications for surgical resection. However, techniques such as preoperative portal embolization 26 and intraoperative ultrasonography, 27 which have been associated with improvements in perioperative patient management, have led to safe hepatic resections with no deaths, even in patients with cirrhosis, 28 and have extended the possibility of liver surgery to patients with advanced metastatic tumors. 29 Therefore, two opposite trends can be recognized: one is toward a less-invasive approach, with broader indications for more conservative therapies such as interstitial treatment, and the other is a more aggressive policy that extends the indications for surgery.
Since 1980, we have applied the same selection criteria to candidates for liver resection, and all of the patients with technically resectable metastases from colorectal cancer actually underwent surgery. In this study, we retrospectively evaluated the long-term results of our series to determine the factors that affected the prognosis, and then tried to clarify the surgical indications.