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ObjectiveTo define the long-term outcome and treatment complications for patients undergoing liver resection for multiple, bilobar hepatic metastases from colorectal cancer. MethodsA retrospective analysis of 165 consecutive patients undergoing liver resection for metastatic colorectal cancer was performed. Patients were divided into a simple hepatic metastasis group, consisting of patients with three or fewer metastases in a unilobar distribution, and a complex hepatic metastases group, consisting of patients with four or more unilobar metastases or at least two bilobar metastases. ResultsThe 5-year survival rate was 36% for the simple group and 37% for the complex group. Multivariate analysis revealed that the number of hepatic segments involved by tumor and the maximum diameter of the largest metastasis correlated significantly with the 5-year survival rate. The surgical death rate was 4.9% for the simple group and 9.1% for the complex group; this difference was not significant. Multivariate analysis revealed that extended lobar resection and concomitant colon and hepatic resection were significant and independent predictors of surgical death. The combination of extended lobar resection and concomitant colon resection was used significantly more frequently in the complex group than in the simple group. ConclusionsResection of complex hepatic metastases, as defined in this study, results in a 5-year survival rate of 37% and confers the same survival benefit as does resection of limited hepatic metastases. The surgical death rate for this aggressive approach is significantly higher if extended lobar resections are necessary and if concomitant colorectal resection is performed. Patients who have complex hepatic metastases at the time of diagnosis of the primary colorectal cancer and who would require extended hepatic lobectomy should have hepatic resection delayed for at least 3 months after colon resection.Substantial surgical experience, reported from multiple institutions, 1-5 supports the surgical resection of limited, isolated hepatic metastases from colorectal carcinoma, with 5-year survival rates of 30% or more reported routinely. The majority of the surgical experience reported to date has been in patients with one, two, or three metastatic lesions, usually confined to one lobe of the liver. The suitability for resection of patients with more complex hepatic metastatic disease has not been well defined. The multiinstitutional review reported by Hughes et al 6 of 100 patients surviving 5 years or more after resection of hepatic metastases from colorectal cancer included only three patients with four or more metastatic lesions. Scheele et al, 2 in one of the largest single-institution reports to date, reported experience with only 32 patients undergoing resection of four or more metastatic lesions. Further, reports of resection of multiple metastases are confounded by the classification as multiple lesions of clusters of small lesions in close proximity or of satellite lesions around a large metastasis.Bec...

Incisional recurrence is uncommon, although likely underestimated, following conventional treatment of colorectal carcinoma. Its occurrence is usually a harbinger of diffuse intra-abdominal disease. These data may provide useful information for investigations of laparoscopic approaches to colon cancer.

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Patients treated with multicatheter partial breast brachytherapy in this trial experienced excellent in-breast control rates and overall outcome that compare with reports from APBI studies with similar extended follow-up.

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Thirty-five consecutive cases of adenocarcinoma of the ampulla of Vater seen over the past 36 years were reviewed. The introduction of new diagnostic techniques over the course of this study improved the accuracy of preoperative diagnosis but did not lead to earlier diagnosis. The surgical resectability rate was 88%, and 53% of postoperative survivors were free of disease at 5 years. Of the 14 patients with metastases to regional lymph nodes, 27% survived disease-free for 5 years. Surgical mortality was 25% for the entire series but has been reduced to 6.6% over the past decade. Surgical mortality was primarily due to leakage of the pancreaticojejunostomy; the risk of pancreaticojejunostomy leak correlated inversely with the degree of chronic pancreatitis in the pancreatic remnant. In 35% of resected cases, a benign adenomatous component was contained within the cancer of the ampulla of Vater. Cure rates are good for this lesion. The most important factor in maximizing cure rate is careful attention to the technical details of pancreaticojejunostomy in order to minimize surgical mortality. Benign adenomas appear to be a frequent precursor of carcinoma of the ampulla of Vater.

BACKGROUND Male breast carcinoma is rare; therefore, the effect of family history on the course of the disease has not been well described. Germ‐line mutations in breast carcinoma susceptibility genes, particularly BRCA2, are associated with an increased risk of male breast carcinoma. The authors sought to correlate significant family history with clinical phenotype in males with breast carcinoma. METHODS One hundred forty‐two men with breast carcinoma were treated at Memorial Sloan‐Kettering Cancer Center or the Ochsner Clinic from 1973 to 1994. The authors reviewed the effect imparted by a family history of breast carcinoma on the duration of symptoms, the age at diagnosis, and the survival of men with this disease. RESULTS Fifteen percent of male breast carcinoma patients had a first‐degree relative with the disease. Fifty‐eight years was the mean age at diagnosis for those with a family history, compared with 61 years for those without (P = not significant [NS]). The mean duration of symptoms was 23 months for those with a family history, compared with 22 months for those without. Three of 22 patients (13.6%) with a family history, compared with 11 of 90 patients (12%) without a family history, had Stage III disease (P = NS) at presentation. The overall 5‐year and 10‐year survival rates were 86% and 64%. Survival was not affected by family history. Lymph node positivity reduced 5‐year and 10‐year survival rates to 73% and 50% (P = 0.0004). CONCLUSIONS For men with breast carcinoma, the presence of a family history did not affect the age at presentation, the duration of symptoms, the stage of disease at presentation, or the overall survival. In multivariate analysis, the most powerful predictor of outcome for these men was the status of the axillary lymph nodes. [See editorial on pages 744–6, this issue.] Cancer 1999;86:821–5. © 1999 American Cancer Society.