SURGICAL MARGIN IN HEPATIC RESECTION FOR COLORECTAL METASTASIS - A CRITICAL AND IMPROVABLE DETERMINANT OF OUTCOME

Objective To update the analysis of technical and biologic factors rel ated to hepatic resection for colorectal metastasis ina large single-i nstitution series to identify important prognostic indicators and patt erns of failure. Summary Background Data Surgical therapy for colorect al carcinoma metastatic to the liver is the only potentially curable t reatment. Careful patient selection of those with resectable liver-onl y metastatic disease is crucial to the success of surgical therapy. Me thods Two hundred forty-four consecutive patients undergoing curative hepatic resection for metastatic colorectal carcinoma were analyzed re trospectively. Variables examined included sex, stage of primary lesio n, size of liver lesion(s), number of lesions, disease-free interval, ploidy, differentiation; preoperative carcinoembryonic antigen level, and operative factors such as resection margin, use of cryotherapy, in traoperative ultrasound, and blood loss. Results Surgical margin, numb er of lesions, and carcinoembryonic antigen (CEA) levels significantly control prognosis. Patients with only one or two liver lesions, a 1-c m surgical margin, and low CEA levels have a 5-year disease-free survi val rate of more than 30%. Disease-free interval, original stage, bilo bar involvement, size of metastasis, differentiation, and ploidy were not significant predictors of recurrence. The pattern of failure corre lates with surgical margin. Routine use of intraoperative ultrasound r esulted in an increased incidence of negative surgical margin during t he period examined. Conclusions Surgical resection or cryotherapy of h epatic metastasis from colorectal cancer is safe and curable in approp riately selected patients. Biologic factors, such as number of lesions and carcinoembryonic antigen levels, determine potential curability, and surgical margin governs the patterns of failure and outcome in pot entially curable patients. Optimization of selection criteria and surg ical resection margins will improve outcome.