First results and complications of surgery for liver metastases

Following resection of liver metastases the overall prognosis still remains limited because of the lack of adjuvant therapy. The number of explorative laparotomies, non-radical resections and complications needs to be reduced . One hundred and ten laparotomies in 97 patients with liver metastases wer e performed with the intention to cure between October 1993 and February 19 98. In a prospective analysis we reviewed: patient characteristics, charact eristics of primary tumors and metastases, part and extent of liver resecti on, radicality, complications and mortality. Additionally, a prospective st udy about the value of ultrasonography and CT scan concerning the evaluatio n of preoperative liver findings was undertaken between January 1995 and Fe bruary 1998. Altogether, resection of liver metastases was achieved in 75 c ases (68.2 %). Nineteen patients (25.3 %) had postoperative complications. Two patients (2.7 %) died following liver resection. Thirty-five operations (31.8 %) had to be finished as only an explorative laparotomy. The major r eason for these restricted operations was in 15 patients (42.9 %) regional recurrence or peritoneal metastases. Preoperative determination of the live r finding (quantity, localization and size) by ultrasonography and CT scan achieved an accuracy of 68.9 % each. The results of this analysis show that resection of liver metastases can be accomplished with minor morbidity and mortality. The high number of explorative laparotomies still remains a cen tral problem in the surgery of liver metastases. By the introduction of dup lex sonography and contrast-medium-enhanced helical CT scan, liver patholog y can be defined more precisely in the preoperative evaluation. However, pr eoperative detection of regional recurrence or peritoneal metastases remain s difficult.