Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1986 Jan;203(1):49–54. doi: 10.1097/00000658-198601000-00009

Surgical treatment of hepatic metastases from colorectal cancer.

L Gennari, R Doci, P Bignami, F Bozzetti
PMCID: PMC1251038  PMID: 3942421

Abstract

From 1980 to 1984, 48 patients were subjected to liver resection for hepatic metastases from colorectal cancer. The disease was staged according to the original staging system proposed by the authors: stage I, single metastasis involving less than 25% of hepatic parenchyma (21 patients); stage II, multiple metastases involving less than 25% of hepatic parenchyma or single metastasis involving between 25-50% (9 patients); and stage III, multiple metastases involving between 25-50% or more than 50% of hepatic parenchyma, irrespective of the number of metastases (18 patients). The extent of hepatic resection was generally related to that of liver disease; a typical lobectomy was performed in 28 patients and segmentectomies in 20. One patient died after operation (mortality, 2.1%), and major complications occurred in seven patients (morbidity, 14.9%). Morbidity was related to operatory blood loss: 45% of patients with blood replacement of more than 2000 cc developed major complications versus 5.4% with blood replacement of less than 2000 cc (p less than 0.05). The actuarial 3-year survival for stages I, II, and III was 73%, 60%, and 29%, respectively (p less than 0.05). Twenty-two patients (45%) have had recurrences, all stage III patients within 2 years of resection versus 28% of stage I patients (30 months disease-free survival, 49%). The liver only was the site of recurrence in 10 patients, distant sites in seven, and both liver and distant in five. Analysis of the different features of the primary tumor, the interval between bowel resection and detection of hepatic metastases, and the number and extent of liver secondaries demonstrated that prognosis after surgery was mainly related to the latter; they are considered in the staging system adopted in this study. It is a simple system and shows a good prognostic correlation. The results reported here are in agreement with those of the literature; the low mortality and morbidity and the survival benefit support the growing acceptance of surgery in treatment of hepatic metastases from colorectal cancer, in particular stage I patients. For the other stages, surgery should represent, when applicable, only the first step of a multimodality treatment.

Full text

PDF
49

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adson M. A., Van Heerden J. A. Major hepatic resections for metastatic colorectal cancer. Ann Surg. 1980 May;191(5):576–583. doi: 10.1097/00000658-198005000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Almersjö O., Bengmark S., Rudenstam C. M., Hafström L., Nilsson L. A. Evaluation of hepatic dearterialization in primary and secondary cancer of the liver. Am J Surg. 1972 Jul;124(1):5–9. doi: 10.1016/0002-9610(72)90155-9. [DOI] [PubMed] [Google Scholar]
  3. Attiyeh F. F., Wanebo H. J., Stearns M. W. Hepatic resection for metastasis from colorectal cancer. Dis Colon Rectum. 1978 Apr;21(3):160–162. doi: 10.1007/BF02586558. [DOI] [PubMed] [Google Scholar]
  4. Baden H., Andersen B. Survival of patients with untreated liver metastases from colorectal cancer. Scand J Gastroenterol. 1975;10(2):221–223. [PubMed] [Google Scholar]
  5. Bengmark S., Hafström L., Jeppsson B., Jönsson P. E., Rydén S., Sundqvist K. Metastatic disease in the liver from colorectal cancer: an appraisal of liver surgery. World J Surg. 1982 Jan;6(1):61–65. doi: 10.1007/BF01656374. [DOI] [PubMed] [Google Scholar]
  6. Bengmark S., Rosengren K. Angiographic study of the collateral circulation to the liver after ligation of the hepatic artery in man. Am J Surg. 1970 Jun;119(6):620–624. doi: 10.1016/0002-9610(70)90228-x. [DOI] [PubMed] [Google Scholar]
  7. Bengtsson G., Carlsson G., Hafström L., Jönsson P. E. Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg. 1981 May;141(5):586–589. doi: 10.1016/0002-9610(81)90057-x. [DOI] [PubMed] [Google Scholar]
  8. Dahl E. P., Frelund P. E., Tylén U., Bengmark S. Transient hepatic dearterialization followed by regional intra-arterial 5-fluorouracil infusion as treatment for liver tumors. Ann Surg. 1981 Jan;193(1):82–88. doi: 10.1097/00000658-198101000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. El-Domeiri A. A., Mojab K. Intermittent occlusion of the hepatic artery and infusion chemotherapy for carcinoma of the liver. Am J Surg. 1978 Jun;135(6):771–775. doi: 10.1016/0002-9610(78)90161-7. [DOI] [PubMed] [Google Scholar]
  10. Fortner J. G., Silva J. S., Golbey R. B., Cox E. B., Maclean B. J. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection. Ann Surg. 1984 Mar;199(3):306–316. doi: 10.1097/00000658-198403000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Foster J. H., Lundy J. Liver Metastases. Curr Probl Surg. 1981 Mar;18(3):157–202. doi: 10.1016/s0011-3840(81)80009-3. [DOI] [PubMed] [Google Scholar]
  12. Gennari L., Doci R., Bozzetti F., Veronesi U. Proposal for a clinical classification of liver metastases. Tumori. 1982 Oct 31;68(5):443–449. doi: 10.1177/030089168206800515. [DOI] [PubMed] [Google Scholar]
  13. Goslin R., Steele G., Jr, Zamcheck N., Mayer R., MacIntyre J. Factors influencing survival in patients with hepatic metastases from adenocarcinoma of the colon or rectum. Dis Colon Rectum. 1982 Nov-Dec;25(8):749–754. doi: 10.1007/BF02553304. [DOI] [PubMed] [Google Scholar]
  14. Jaffe B. M., Donegan W. L., Watson F., Spratt J. S., Jr Factors influencing survival in patients with untreated hepatic metastases. Surg Gynecol Obstet. 1968 Jul;127(1):1–11. [PubMed] [Google Scholar]
  15. Kortz W. J., Meyers W. C., Hanks J. B., Schirmer B. D., Jones R. S. Hepatic resection for metastatic cancer. Ann Surg. 1984 Feb;199(2):182–186. doi: 10.1097/00000658-198402000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Lahr C. J., Soong S. J., Cloud G., Smith J. W., Urist M. M., Balch C. M. A multifactorial analysis of prognostic factors in patients with liver metastases from colorectal carcinoma. J Clin Oncol. 1983 Nov;1(11):720–726. doi: 10.1200/JCO.1983.1.11.720. [DOI] [PubMed] [Google Scholar]
  17. Morrow C. E., Grage T. B., Sutherland D. E., Najarian J. S. Hepatic resection for secondary neoplasms. Surgery. 1982 Oct;92(4):610–614. [PubMed] [Google Scholar]
  18. Nims T. A. Hepatic trisegmentectomy for metastatic colorectal cancer. J Surg Oncol. 1983 Oct;24(2):154–156. doi: 10.1002/jso.2930240218. [DOI] [PubMed] [Google Scholar]
  19. Nims T. A. Resection of the liver for metastatic cancer. Surg Gynecol Obstet. 1984 Jan;158(1):46–48. [PubMed] [Google Scholar]
  20. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Rajpal S., Dasmahapatra K. S., Ledesma E. J., Mittelman A. Extensive resections of isolated metastasis from carcinoma of the colon and rectum. Surg Gynecol Obstet. 1982 Dec;155(6):813–816. [PubMed] [Google Scholar]
  22. Rapoport A. H., Burleson R. L. Survival of patients treated with systemic fluorouracil for hepatic metastases. Surg Gynecol Obstet. 1970 May;130(5):773–777. [PubMed] [Google Scholar]
  23. Stehlin J. S., Jr, Hafström L., Greeff P. J. Experience with infusion and resection in cancer of the liver. Surg Gynecol Obstet. 1974 Jun;138(6):855–863. [PubMed] [Google Scholar]
  24. Taylor B., Langer B., Falk R. E., Ambus U. Role of resection in the management of metastases to the liver. Can J Surg. 1983 May;26(3):215–217. [PubMed] [Google Scholar]
  25. Wagner J. S., Adson M. A., Van Heerden J. A., Adson M. H., Ilstrup D. M. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg. 1984 May;199(5):502–508. doi: 10.1097/00000658-198405000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Wilson S. M., Adson M. A. Surgical treatment of hepatic metastases from colorectal cancers. Arch Surg. 1976 Apr;111(4):330–334. doi: 10.1001/archsurg.1976.01360220026004. [DOI] [PubMed] [Google Scholar]
  27. Wood C. B., Gillis C. R., Blumgart L. H. A retrospective study of the natural history of patients with liver metastases from colorectal cancer. Clin Oncol. 1976 Sep;2(3):285–288. [PubMed] [Google Scholar]
  28. Wood C. B., Gillis C. R., Blumgart L. H. A retrospective study of the natural history of patients with liver metastases from colorectal cancer. Clin Oncol. 1976 Sep;2(3):285–288. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES