Surgical resection for colorectal hepatic metastases

Hepatic resection of metastatic disease due to primary colorectal cancer provides a relatively safe and reliable method to control this otherwise fatal disease. At New York University 45 hepatic resections have been performed in 42 patients over the last fifteen years. Preoperative screening was performed by liver chemistry and intraoperative exploration in synchronous lesions and by liver chemistry, carcinoembryonic antigen, and computed tomography in metachronous lesions. Careful monitoring of fluid management, glucose utilization, and albumin requirements are essential for low postoperative morbidity and mortality. In major hepatic resections, changes in coagulation profile correlate with normalization of hepatic function as evidenced by decrease in serum bilirubin levels and increase bile production. The incidence of major operative morbidity was 17%; operative mortality was 4%. Hepatic resection gives the greatest possibility of extended survival, in our patients providing a 22% crude five year survival rate and a mean duration of survival of 33 months.