Effect of occult hepatic metastases on survival after curative resection for colorectal carcinoma

Computed tomography and ultrasonography of the liver were performed during the immediate postoperative period in 35 consecutive patients undergoing apparently curative resection for colorectal carcinoma. On the basis of these investigations, occult hepatic metastases were detected and confirmed by sequential imaging in 11 patients. All patients were followed for a minimum of 3 yr. Of these 35 patients, 2, 10, and 23 were allocated to the traditional Dukes' stages A, B, and C, respectively. The corresponding 3-yr survival was 100%, 70%, and 57%. The 11 patients with occult hepatic metastases at the time of surgery were allocated to the Dukes' B group in 2 cases and the Dukes' C group in 9 cases. When these 11 patients are excluded from the traditional Dukes' staging, the corrected survival of the A, B, and C groups was 100%, 88%, and 86%, respectively. Only 1 of the patients with occult hepatic metastases survived 3 yr. These results show that the presence of occult hepatic metastases predominantly explains the pattern of early death after apparently curative resection for colorectal carcinoma.