RESECTION OF COLORECTAL LIVER METASTASES

From 1960 to 1992 a total of 1718 patients with liver metastases from colorectal carcinoma were recorded. Of these patients, 469 (27.3%) und erwent hepatic resection, which was performed with curative intent in 434 patients (25.3%). Operative mortality in this group was 4.4%, bein g 1.8% (2 of 114) during the last 3 years. Significant morbidity was o bserved in 16% of patients with a decrease to 5% (6 of 112) for the la st 3 years. A 99.8% follow-up until November 1, 1993 was achieved. Exc luding operative mortality, there are 350 patients with ''potentially curative'' resection and 65 corresponding patients with minimal macros copic (n = 19) or microscopic (n = 46) residual disease. The latter gr oup demonstrated a poor prognosis, with median and maximum survival ti mes of 14.4 and 56.0 months, respectively. Among the 350 patients havi ng potentially curative resection, the actuarial 5-, 10-, and 20-year survivals were 39.3%, 23.6%, and 17.7%, respectively. Tumor-free survi val was 33.6% at 5 years. In the univariate analysis, the following fa ctors were associated with decreased crude survival: presence and exte nt of mesenteric lymph node involvement (p = 0.0001); grade III/IV pri mary tumor (p = 0.013); synchronous diagnosis of metastases (p = 0.014 ); satellite metastases (p = 0.00001); metastasis diameter of > 5 cm ( p = 0.003); preoperative carcinoembryonic antigen (CEA) elevation (p, = 0.03); limited resection margins (p = 0.009); extrahepatic disease ( p = 0.009); and nonanatomic procedures (p = 0.008). With respect to di sease-free survival, extrahepatic disease (p = 0.09) failed to achieve statistical significance, whereas patients with primary tumors in the colon did significantly better than those with rectal cancer (p = 0.0 4). The presence of five or more independent metastases adversely affe cted resectability (p < 0.05). However, once a radical excision of all detectable disease was achieved, no significant predictive value of a n increasing number of metastases (1-3 versus greater than or equal to 4) on either overall (p = 0.40) or disease-free (p = 0.64) survival w as found. Using Cox's multivariate regression analysis, the presence o f satellite metastases, primary tumor grade, the time of metastasis di agnosis, diameter of the largest metastasis, anatomic versus nonanatom ic approach, year of resection, and mesenteric lymph node involvement each independently affected both crude and tumor-free survival.