Hepatic resection for metastasis from colorectal cancer

Liver metastases from colorectal cancer are treatable and potentially curable when hepatic resection is applied. This paper is to illustrate surgical treatment of metastatic colorectal cancer in China.

Between January 1993 and December 2002, 485 patients with colorectal liver metastases from 6 institutes in China were reviewed. Among them were 340 males and 145 females with average ages of 55.6 years (23-81). Surgical intervention includes primary colorectal cancer resection, hepatic resection, hepatic arterial chemoembolisation and portal vein catheterisation, and systemic chemotherapy.

Among 485 cases, data were not complete in 76, and their 3-year survival rate was 35.7%, while from 409 patients who underwent surgical intervention, 11 cases only underwent colorectal cancer resection (group A); 89 with hepatic resection (group B); 204 with hepatic arterial intervention or portal vein catheterisation chemotherapy (group C); 21 with regional ablation by radiofrequency or microwave thermal coagulation (group D); and 84 with systemic chemotherapy (group E). The cumulative 3- and 5-year survival rates were 0% in groups A and E, 43.5% and 32.1% in group B, 27.1% and 0% in group C, and 42.9% and 19.2% in group D.

Surgery can offer long-term survival and resection should be considered when liver metastases can be totally resected with clear margins and when there is no nonresectable extrahepatic disease. The choice between anatomical or wedge resection depends on the number and the location of the metastases. Special multifunctional operative device limit blood loss and increase resectability.