Hepatic resection for colorectal liver metastases

Nearly 50 percent of patients who have colorectal carcinoma will develop liver metastases, which is frequently the cause of death. Liver resection is the only curative treatment for patients with colorectal metastases confined to the liver. However, liver resection can be performed in only ten percent of patients. A strategy to improve resectability and outcome of patients with colorectal liver metastases is needed.

The progress and outcome of patients, who had colorectal liver metastases and underwent liver resection in a tertiary surgical centre between January 1998 and December 2002, were retrospectively studied.

During the five-year study period, 42 patients with colorectal liver metastasis underwent hepatic resection. 36 patients received primary liver resection. Six patients with initially unresectable disease received salvage surgery after tumour downstaging with systemic chemotherapy. Five of the 42 patients needed repeat liver resection for recurrent colorectal liver metastases. The hospital mortality rate was 2.1 percent. 11.9 percent of patients had major postoperative complications. The median survival was 49 months. The one-, three- and five-year overall survival rates after resection were 91 percent, 54 percent, and 37 percent, respectively; and the recurrence rate was 76 percent. The five-year survival rate with salvage surgery after tumour downstaging was 34 percent, and the corresponding figure, after repeat liver resection, for recurrent liver metastases was 27 percent.

Hepatic resection for colorectal metastases confined to the liver resulted in reasonably good long-term survival, with acceptably low operative mortality and morbidity. Our results were compatible with the international standard of liver resection for colorectal liver metastases.