Interval hepatic resection of colorectal metastases improves patient selection

Hypothesis: Interval reevaluation for resectability of hepatic colorectal m etastases aids patient selection. Design: A retrospective review. Setting: A tertiary care medical center. Patients and Methods: From January 1, 1985, to July 1, 1998, 318 patients w ith colorectal hepatic metastases were identified. Resectable lesions (N = 73) were divided into synchronous (n = 36) or metachronous (n = 37) and ret rospectively reviewed for immediate resection or interval revaluation. Kapl an-Meier survival curves of treatment groups were compared by the log-rank test. Results: Survival curves of patients with synchronous and metachronous lesi ons undergoing interval reevaluation vs immediate resection were not signif icantly different (P = .74 and P = .65, respectively). No lesions from pati ents who underwent interval reevaluation became unresectable due to growth of the initial metastases. After interval reevaluation, 8 (29%) of 28 patie nts with synchronous metastases were spared the morbidity of laparotomy bec ause of distant or an increased number of metastases and (36%;) of 28 patie nts were spared the morbidity of hepatic resection at the time of internal laparotomy. Actuarial median and 5-year survival of patients after delayed hepatic resection (51 months and 45%, respectively) were significantly impr oved compared with those of all other patients with respectable metastases (23 months and 7%, respectively) (P = .02). For patients with metachronous lesions who underwent interval reevaluation, 4 (29%) of 14 patients were sp ared the morbidity of laparotomy because of an increased number of hepatic or distant metastases. Conclusions: Delaying hepatic resection for metastatic colorectal cancer do es not impair survival. Potentially, two thirds of patients can avoid major hepatic surgery. For synchronous metastases. delaying hepatic resection ap pears to select patients who will benefit from hepatic resection.