Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma

Background: Although systematic anatomical hepatic resection has been repor ted to improve patient survival in hepatocellular carcinoma, principles of hepatectomy procedure have not been clearly demonstrated in secondary hepat ic malignancy. The purpose of the present study was to determine whether se lection of surgical procedures for liver resection is associated with the p attern of tumor recurrence or patient survival. Methods: During the period of 1980 through 1999, 174 cases underwent liver resection for hepatic metastasis from colorectal cancer. Of these, 96 under went systematic anatomical major hepatic resection (anatomical group) and 7 8 cases underwent nonanatomical limited resection (nonanatomical group). Su bset analysis of 115 patients with unilobar single or double tumors was als o conducted. Results: The overall 5-year survival rate of 174 patients was 43.2%. Univar iate analysis did not show a significant difference in patient survival acc ording to surgical procedure (anatomical group versus nonanatomical group). Operative morbidity and mortality rates were slightly higher in anatomical group. From the subset analysis in unilobar single or double tumors, anato mical major hepatectomy was unnecessary in 80.4% of the cases if the tumors were resectable by nonanatomical limited resection. Ninety percent of the ipsilateral recurrence, which could have been avoided if the first operatio n was anatomical hemihepatectomy, could undergo second hepatectomy with 5-y ear survival rate of 58.3%. Conclusions: There was not a significant difference in patient survival acc ording to surgical procedure. To minimize surgical stress and operative ris k, nonanatomical limited liver resection should be a basic surgical procedu re for colorectal metastases. (C) 2001 Excerpta Medica, Inc. All rights res erved.