Purpose: More than 50,000 patients in the United States will present e
ach year with liver metastases from colorectal cancers. The current st
udy was performed to determine if liver resection for colorectal metas
tases is safe and effective and to evaluate predictors of outcome. Mat
erials and Methods: Data for 456 consecutive resections July 1985 and
December 1991 in a tertiary referral center were analyzed. Results: Th
e perioperative mortality rate was 2.8%, with ct mortality rate of 4.6
% for resections that involved a lobectomy or more. The median hospita
l stay was 12 days and only 9% of patients were admitted to the intens
ive care unit. The 5-year survival rate is 38%, with a median survival
duration of 46 months. By univariate analysis, nodal status of the pr
imary lesion, short disease-free interval before detection of liver me
tastases, carcinoembryonic antigen (CEA) level greater than 200 ng/mL,
multiple liver tumors, extrahepatic disease, large tumors, or positiv
e resection margin was predictive of poorer outcome. Sex, age greater
than 70 years, site of primary tumor, or perioperative transfusion was
not predictive of outcome. By multivariate analysis, positive margin,
size greater than 10 cm, disease-free interval less than 12 months, m
ultiple tumors, and extrahepatic disease were independent predictors o
f poorer outcome. Short disease-free interval or multiple tumors were
nevertheless associated with a 5-year survival rate greater than 24%.
Conclusion: Liver resection for colorectal metastases is safe and effe
ctive therapy and currently represents the only potentially curative t
herapy for metastatic colorectal cancer. The only absolute contraindic
ation to resection is extrahepatic disease. A randomized trial to exam
ine efficacy of surgical resection cannot ethically be performed. Live
r resection should be considered standard therapy for all fit patients
with colorectal metastases isolated to the liver. (C) 1997 by America
n Society of Clinical Oncology.