Surgical experience with hepatic colorectal metastasis

The outcome of 134 patients undergoing hepatic resection for colorectal met astasis was studied. Current follow-up was available in 98 per cent of pati ents, for more than 5 years in 58 patients, and totaling 360 patient-years. Patients (52% male) had an average age of 62 +/- 1 years (standard error o f the mean). Time lapse between the primary colon surgery and hepatic resec tion was a median of 16 months and a mean of 19 +/- 1 months. Thirty-two (2 4%) were operated on within 6 months for both their primary tumor and hepat ic metastasis. Intensive care unit and total hospital length of stay were a median of 1 and 7 days, respectively. Pathology reports demonstrated that on average there were 2.0 +/- 0.1 lesions, with the largest lesion measurin g 4.4 +/- 0.2 cm. In 72 per cent of patients, the lesions were found in one lobe only. CEA was elevated in 83 per cent of patients preoperatively and was 60 +/- 11 ng/mL before and 4.0 +/- 0.5 ng/mL after hepatic resection. P atient survival was 81 per cent at 1 year, 50 per cent at 3 years, 36 per c ent at 5 years, and 23 per cent at 10 years. Actual 5- and 10-year survival was 22 of 58 (38%) patients and 4 of 21 (19%) patients respectively. Disea se-free survival was 58 per cent at 1 year, 27 per cent at 3 years, 16 per cent at 5 years, and 12 per cent at 7 years. Survival was much better for o ne to four lesions than for five or more lesions (P < 0.01). Several other potential risk factors did not affect survival, including whether the patie nt received chemotherapy after hepatic resection. There were 36 (43%) patie nts who recurred with hepatic involvement only, 27 (32%) including hepatic involvement and 21 (25%) with nonhepatic involvement only. There were 15 pa tients who went on to receive repeat hepatic resections, with a 5-year surv ival of 74 per cent and disease-free survival of 58 per cent. Hepatic resec tion provides the best outcome of any form of therapy for selected patients with isolated hepatic metastasis.