HEPATIC RESECTION FOR METASTATIC COLORECTAL-CANCER

One-hundred thirty-one primary hepatic resections for colorectal secon dary tumors were performed at Rush-Presbyterian-St.Luke's Medical Cent er between 1975 and 1993. Perioperative mortality occurred in five pat ients (3.8%). Twenty-three patients had minor morbidities (18%); major morbidity occurred only in the five patients who died. Curative resec tions were performed in 107 patients. Overall actuarial survival at 2, 3, and 5 years was 62, 45 and 25 per cent, respectively. Patients wit h extrahepatic disease (5-year survival, 0% vs 27%; P = 0.049) and pos itive resection margins (0% vs 30%; P < 0.001) had significantly poore r survival. Among the curative resections, patients who had metachrono us hepatic resections did significantly better than those who underwen t synchronous colon and hepatic resections (35% vs 13%; P = 0.002). Th is survival benefit persisted when comparison was restricted to patien ts with synchronous metastases. Age, sex, race, number of lesions, sit e of colon primary resection, blood transfusion, disease-free interval , and extent of resection had no effect on survival. All patients who are acceptable surgical risks with potentially resectable metastatic c olorectal cancer confined to the liver should undergo exploration. Ass essment of resectability should include intraoperative ultrasound in a ll patients to maximize the probability of tumor clearance.