J.Jpn. Surg. Soc.. 104(10): 701-706, 2003

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Feature topic

TREATMENT STRATEGY FOR HEPATIC METASTASES OF COLORECTAL CANCER

Over the past 25 years, 125 patients with colorectal liver metastases underwent 167 hepatectomies in our department. The 1- ,3- , and 5-year survival rates after the initial hepatectomy were 90%, 58%, and 51%, respectively, and those after repeated hepatectomy were 88%, 60%, and 42%, respectively. The predictive factors significantly associated with poor prognosis after initial hepatectomy were maximal diameter of metastasis (≧5 cm), distribution pattern in the liver (multiple bilobar), number of nodules (≧four), and presence of extrahepatic metastases. A disease-free interval of >6 months after initial hepatectomy was a significant factor for prolongation of survival after repeat hepatectomy. Patients with hilar node metastases at the initial hepatectomy did not receive a survival benefit from hepatectomy, while 5 patients underwent repeat hepatectomy with lymphadenectomy for remnant liver and hilar node metastases with a disease-free interval of >8 months and 4 of them survived for >5 years.
Our treatment strategies for colorectal hepatic metastases are as follows : 1) hepatectomy is the first choice for <4 liver metastases without extrahepatic disease ; 2) a careful evaluation for liver resection is performed for patients with ≧4 liver metastases receiving hepatic arterial infusion chemotherapy because of the high frequency of hepatic and/or extrahepatic recurrence after initial hepatectomy ; 3) the presence of hilar node metastases at the initial hepatectomy should be excluded from surgical indications : 4) simultaneous single metastasis limited to the lung is an indication for lung resection ; and 5) a suitable indication for repeat hepatectomy for hepatic recurrence is patients with a longer disease-free interval.
Aggressive surgery based on the optimum patient selection can contribute to clinical benefit, including long-term survival in patients with colorectal liver metastases.

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