Hepatic resection for metastases in colorectal carcinoma

To outline the role of liver resection in the treatment of colorectal liver metastases, with particular reference to hospital morbidity, mortality and subsequent survival.

Seventy major liver resections were performed in Wellington by the senior author (RSS) between 1987 and 1997 for colorectal metastases. Fifty-three entailed resection alone with intent to cure, nine were associated with additional cryotherapy and in eight hepatic arterial chemotherapy was subsequently given. Resection was the initial form of liver treatment in all 70 patients. Patients were aged between 29 and 76 years with a median of 60.0 years. All patients were judged pre-operatively to have tumour confined to a resectable portion of the liver. Data were collected prospectively and held in a computerised database. Follow-up was available on all patients.

Median operating theatre time was five hours and median blood loss was 1500 mL (60 mL-25 L). Eighty percent of resections entailed four or more liver segments. Postoperative morbidity occurred in 26 (37.1%) and 30-day mortality was 5.7%. Median hospital stay was 11 days (2-67). In the 53 patients who underwent resection alone, the three and five-year actuarial survival rates, including the 30-day mortality, were 62.0% and 27.2%, respectively. Dukes stage of the primary was the only significant prognostic factor found in this subgroup of patients (p<0.05).

Resection of colorectal liver metastases can achieve extension of life and long-term survival in selected patients. However, it remains a major undertaking and is probably best performed in units with appropriate expertise and experience.