Elsevier

Surgery

Volume 143, Issue 6, June 2008, Pages 706-714
Surgery

Original Communication
Prognostic value of concomitant resection of extrahepatic disease in patients with liver metastases of colorectal origin

https://doi.org/10.1016/j.surg.2008.02.004Get rights and content

Background

Operative resection is the treatment of choice for colorectal liver metastasis. In the present study, we investigated the prognostic factors after hepatic resection, focusing on the concomitant resection of extrahepatic metastases.

Method

A retrospective cohort study was performed in 187 consecutive patients who had undergone initial hepatic resections for colorectal metastases using the Cox proportional hazards model.

Results

The overall survival rates at 3, 5, and 10 years were 49%, 30%, and 22%, respectively. Hilar lymph node involvement (HLN), localized peritoneal seeding (P), and distant organ metastasis (M) were resected in addition to the liver metastases in 9, 13, and 21 patients, respectively. The P and M factors were related univariately to an unfavorable patient prognosis, but the HLN factor was not. In a multivariate regression analysis, the hazard ratios of these three factors of interest were 1.58 (HLN; 95% confidence interval 0.64–2.52, median survival 48 months), 2.12 (P; 1.38–2.85, 18 months), and 3.07 (M; 2.45–3.68, 19 months), respectively.

Conclusion

Aggressive operative resection for colorectal liver metastases yielded an acceptable long-term outcome. The presence of distant organ metastasis seems to be a contraindication for operative intervention and/or resection; although the number of patients enrolled in the present study was small, resection of localized peritoneal seeding or hilar lymph node involvement, in addition to the resection of the liver metastases, may benefit patient survival.

Section snippets

Methods and materials

Data were collected for 254 patients who had undergone hepatic resections with curative intent for the treatment of colorectal metastases in the Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, from September 1988 to August 2005. The principal patient selection criteria were as follows: controlled primary disease, a macroscopic complete resection, and the preservation of an acceptable amount of liver parenchyma (40% of the total liver volume). In this study, a macroscopically

Characteristics of primary neoplasms

The primary neoplasm was located in the colon in 111 patients (59%) and in the rectum in 76 (41%). The degree of tumor differentiation was well differentiated in 92 patients (49%), moderately differentiated in 86 patients (46%), and poorly differentiated in 9 patients (5%). Serosal infiltration was present in 94 patients (50%). In 51 patients (27%) no lymph node metastases were found, while regional lymph node involvement was present in 122 patients (65%), and para-aortic lymph node involvement

Discussion

In the present study, we attempted to evaluate the survival benefit enabled by the resection of extrahepatic disease in patients with liver metastases of colorectal origin by analyzing retrospectively the long-term results after hepatic resection in this patient cohort. We have been using an aggressive approach to colorectal liver metastases with curative intent, and extrahepatic metastases were resected simultaneously with hepatic metastases, whenever a macroscopically curative resection with

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