Hepatic resection for secondary neoplasms

Despite recent advances in chemotherapy, patients with hepatic metastases treated nonsurgically continue to have a dismal survival rate. Using our experience with surgical resection of pulmonary metastases as a model, we have adopted an aggressive surgical approach to secondary hepatic neoplasms. Hepatic resection for metastatic disease in 64 patients undergoing 75 celiotomies resulted in a cumulative survival rate of 45% at 2 years and 34% at 5 years. Operative procedures included 37 wedge resections, 20 segmentectomies, 16 lobectomies, and 2 total hepatectomies in preparation for liver allograft transplantation. The operative mortality rate (less than 30 days) was significant (20%). The most favorable prognosis was associated with Wilms tumor (4 patients) and colorectal carcinomas (29), the 2-year survivals being 80% and 67%, respectively. Long-term survivors include patients with Wilms (17 and 14 years), leiomyosarcoma (12 years), and colorectal (11 and 10 years) primary tumors. Thirty patients with synchronous resections of the primary tumor and the hepatic resections had 2- and 5-year survival rates of 29% and 26%, whereas 34 patients with metachronous resections had survival rates of 64% and 30%. Eighteen patients underwent resections of multiple hepatic metastases with a survival rate essentially no worse than that of patients with isolated metastases, but careful case selection may have played an important role in the outcome. The extent of hepatic resection was primarily dictated by location and number of metastases. More extensive resections were not associated with a higher long-term survival rate but did have a higher operative mortality. We conclude that an aggressive surgical approach in the treatment of metastatic disease confined to the liver offers a chance for long-term survival and significant palliation in selected patients whose primary tumor is controlled.