Hepatic resection: Effective treatment for primary and secondary tumors

Background. Hepatic resection is an accepted therapeutic modality for isola ted colorectal metastases (CRM) and primary hepatobiliary cancers (PC). Con troversy continues regarding the safety, efficacy, and appropriateness of r esection for noncolorectal metastases (NCM). Methods. A retrospective review of 167 resections in 160 patients was perfo rmed to evaluate the impact of demographics and perioperative data on survi val and recurrence. Statistical analyses were performed by Student t test, analysis of variance, and Kaplan-Meier survival estimates. Results. Resections were performed for CRM, 110 of 167 (66 %), NCM 31 of 16 7 (19 %), and PC, 26 of 167 (15 %). The interval from primary to metastases was significantly longer in the NCM group than the CRM group (34.7 +/- 45. 1 vs 18.7 +/- 23.7 months; P <.01). Mean number of lesions was not differen t between groups; however, NCM were larger than CRM (5.9 +/- 4.5 vs 4.5 +/- 2.9 cm; P <.05). Operative complications were significantly greater for PC (54 %) versus CRM and NCM (21 % and 19 %, respectively; P <.02), although length of stay was similar between groups. Perioperative mortality was 2 %. Actuarial survival at 1 year, 3 years, and 5 years was CRM 91 %, 54 %, and 40 %, PC 75 %, 60 %, and 38 %, and NCM 68 %, 36 %, and not available, resp ectively (CRM vs NCM; P <.01 at 3 years). Conclusions. Hepatic resection for primary and secondary malignancy can be performed with minimal morbidity and mortality. Resection of NCM is associa ted with a lower overall survival compared with CRM and PC. The disease-fre e interval from resection of the primary to metastasectomy is prolonged and hepatic recurrence infrequent after resection in the NCM group. These resu lts suggest that tumor biology is a critical determinant of outcome after h epatic resection of primary and secondary hepatic tumors.