[Surgical treatment of colorectal liver metastasis]

The aim of this study was to evaluate retrospectively the long-term results of our approach, which consists of surgically treating every case in which radical resection of all metastatic disease was technically feasible. The indications for surgical resection for liver metastases from colorectal cancer remain controversial. Several clinical risk factors have been reported to influence survival. Between 1980 and 2001, 304 patients underwent curative hepatic resection for metastatic colorectal cancer at our institution. Survival rates and disease-free survival as a function of clinical and pathological determinants were examined retrospectively. The overall 3-, 5, 10-, and 20-year survival rates were 51%, 36%, 26%, and 25%, respectively. The stage of the primary tumor, lymph node metastasis, multiple nodules, a high preoperative CEA level and a short interval between treatment of the primary and metastatic tumors were significantly associated with a poor prognosis. Patients with 4 or more metastases had almost the same survival rate as those with 2 or 3 nodules. Extrahepatic metastases or invasion at hepatectomy did not worsen the survival rate if curatively resected. These results confirm that surgical resection is useful for treating liver metastases from colorectal cancer. While multiple metastases significantly impair patient prognosis, the life expectancy of patients with 4 or more nodules makes their resection mandatory.