LATE RESULTS JUSTIFY RESECTION FOR MULTIPLE HEPATIC METASTASES FROM COLORECTAL-CANCER

Background Whilst hepatic resection is accepted for single colorectal metastases, the role of surgery for multiple deposits is less certain. This study reports results of a programme of aggressive resection of hepatic metastases. Methods Of 150 hepatic resections for colorectal m etastases, 107 patients have completed 1-9 years' follow-up for this a ctuarial survival analysis. Indications for resection were disease con fined to the liver, resectability of all metastases and preservation o f sufficient hepatic parenchyma. Results One patient (1 per cent) died after operation and six (6 per cent) suffered serious complications ( two surgical and four medical) but with full recovery. Patients who ha d a radical resection (n = 89) had 1- and 5-year survival rates of 94 and 37 per cent respectively. A palliative group (n = 18) with disease elsewhere (n = 9) or positive histological margins (n = 9) had corres ponding survival rates of 56 and 6 per cent. Univariate analysis of th e group who had radical surgery demonstrated that survival depended on size of metastases (less than 7 cm) (P = 0.014), width of clear resec tion margin (greater than 5 mm) (P = 0.004) and primary site (P = 0.01 0). Factors not affecting outcome were number of metastases, unilatera l versus bilateral disease, synchronous versus metachronous spread, tu mour differentiation and Dukes stage. Multivariate analysis demonstrat ed independent survival advantage for small metastases (less than 7 cm ) (P = 0.002) and clear resection margin greater than 5 mm (P = 0.037) . Conclusion Hepatic resection in selected patients with single and mu ltiple colorectal hepatic metastases is justified.