Dis Colon Rectum. Author manuscript; available in PMC Mar 16, 2011.
Published in final edited form as:
Dis Colon Rectum. Jan 1988; 31(1): 1–4.
Resection of the Liver for Colorectal Carcinoma Metastases
A Multi-institutional Study of Long-term Survivors
1University of California, Davis, Medical Center
2Brown University Program in Medicine, Providence, Rhode Island
3Mayo Clinic, Rochester, Minnesota
4Memorial Sloan-Kettering Cancer Center, New York, New York
5University of Connecticut, Farmington, Connecticut
6University of Pittsburgh, Pittsburgh, Pennsylvania
7University of California, Los Angeles, California
8Roswell Park, Buffalo, New York
9New England Deaconess Hospital, Boston, Massachusetts
10Grant Hospital, Columbus, Ohio
11New York University, New York, New York
12Hammersmith Hospital, London, England
13University of Alabama, Birmingham, Alabama
14Klinikum der Universitat Heidelberg, Heidelberg, W. Germany
15New York Medical College, Valhalla, New York
16Central Ohio Colon and Rectal Center, Columbus, Ohio
17Cross Cancer Institute, Alberta, Canada
18The Mercy Hospital of Pittsburgh, Pittsburgh, Pennsylvania
19Lahey Clinic, Burlington, Massachusetts
20St Margaret’s Hospital, Pittsburgh, Pennsylvania
21University of Vermont, Burlington, Vermont
22University of Iowa, Iowa City, Iowa
23Royal Free Hospital, London, England
24Kings College Hospital, London, England, John Radcliffe Infirmary, Oxford, England
Liver Metastases are found in over 70 percent of patients dying from carcinoma of the colon and rectum. The only currently available curative treatment for this condition is hepatic resection, which has a five-year survival rate of 33 percent.1
Though this treatment has an impressive survival rate and carries with it a mortality of only about 5 percent,2–5
there remains a reluctance among physicians to refer patients for this procedure.
The purpose of this report is to discuss long-term survivors from this procedure collected in a multi-institutional retrospective review. The authors present these data to confirm that long-term survival is not only possible, but common following hepatic resection for colorectal metastases, and to examine the characteristics of these five-year survivors to evaluate the indications and contraindications for this procedure.
Hepatic resection is the only curative treatment currently available for hepatic metastases. However, physicians remain skeptical as to whether any patient with hepatic metastases can be cured. In addition, there is a feeling that hepatic resection carries too high a mortality to be used widely. Many series have addressed the mortality of hepatic resection, and have consistently found it to be in the range of 5 percent.2–5
This is a very acceptable mortality for patients who have no alternative treatment.
Many series have also addressed the indications and results of this procedure. Though a five-year survival of greater than 25 percent2–7
is a generally accepted figure following resection, there remains a certain degree of skepticism. Many physicians believe that survival and cure are not possible once a patient has hepatic metastases, and these physicians feel that the 25 percent survivals recorded are statistical aberrations or the result of statistical predictions based on short follow-up.
This report presents a collected series of 100 patients who have survived five years after liver resection. In reviewing the literature, there are only 14 patients reported to survive greater than five years after the detection of liver metastases without resection,8–9
and only seven of these were biopsy-proven metastases. The comparison of 100 five-year survivors from this collected series vs.
the 14 five-year survivors without resection in the literature is very suggestive that hepatic resection does extend survival, and is probably curvative in certain cases.
This analysis of the actual survival of those resected prior to 1981 tends to confirm previous reports. It appears that those patients with a smaller number of metastases, more localized primary disease, and longer disease-free interval do have a survival advantage. The effect of margin on survival did not reach statistical significance, but since this factor was only recorded in 25 percent of patients, it should not be discounted yet. It appears that the distribution of multiple metastases, sex, age, type of procedure, size of metastases, and contiguous spread are of less importance in determining prognosis.
An important result of this study is that there are a finite number of five-year survivors in each of the poor prognosis subgroups. There is one five-year survivor with a positive margin on the liver specimen, three with bilobar metastases, 30 with stage C primary cancers, and 12 with solitary metastases, 8 cm or greater in diameter. Though survival in the poor prognosis subgroups is possible, it appears less likely, and decisions regarding surgery must be individualized.
The authors recommend hepatic resection in any patient with one or two isolated liver metastases if these can be removed with a low mortality. A l-cm margin should be obtained if possible. Prognosis will be affected by the stage of the primary cancer, the disease-free interval, and probably by the margin, but these factors alone should not be regarded as contraindications to resection. Patients with three or four metastases should be considered for resection on an individual basis.
Five-year survival following the resection of hepatic metastases is not only possible, but common. The authors recommend that the prognostic factors be considered in determining who should undergo this procedure, but since five-year survival does occur despite these factors, the final decision to resect must be made on an individual basis.