[Extended resection of liver metastases in colorectal cancer]

Over a 10-year period, 166 patients underwent liver resection with curative intent for colorectal secondaries. These included 23 (13.8%) with metastases invading to adjacent organs. Diaphragm (n = 9), major omentum (n = 5), portal vein/inferior vena cava (n = 3), gallbladder/extrahepatic biliary system (n = 3), right adrenal gland (n = 2), and lymph nodes of the hepatoduodenal ligament (n = 1) were resected en bloc together with the metastases. Operative mortality was 4.3% (1/23 patients). Intraoperative findings and the pathologist's report led to the performance of R0 resection in 14 patients, and microscopic residual disease after R1 resection was found in 7 patients; in 2 cases macroscopically visible tumour had to be left behind. Median survival for all patients was 14 months and was significantly less favourable than in patients who had undergone resection of metastases confined to the liver (P = 0.011, long-rank test). The median recurrence-free interval was 6.8 months (P = 0.11). Obviously, patients who had undergone R0 resection and whose CEA serum levels returned to normal after operation benefited the most, and among these a median survival of 17 months was recorded. It is concluded that in patients with liver metastases from colorectal cancer, invasion of the metastases to adjacent organs has significant implications for the prognosis, even if the metastases are resected. It is important to detect this situation preoperatively, to avoid subjecting patients to a treatment that offers little benefit.