In patients with SCLMs, SR provides similar short-term and long-term outcomes as SgR, with a shorter hospital stay. Therefore, in most patients with SCLMs, SR might be considered the treatment of choice.

Background: Increased frequency of hepatic resection and advances in oncological therapy dramatically improved the long-term outcome of the patients with colorectal liver metastases. The aim of the study is to present the short and long-term results after surgery in patients with colorectal liver metastases, in a single center, over the last two decades. Method: Between 1995 and 2014, a curative-intent liver resection was performed in 526 patients with liver only metastases and 71 patients with both hepatic and extrahepatic metastases of colorectal origin. Results: In patients with liver only metastases, the 1-, 3-and 5-years overall survival rates were 89%, 51.9% and 30%, respectively. The morbidity rates were higher in synchronous liver metastases undergoing simultaneous resection. The mortality and survival rates were similar for simultaneous and staged resections (p>0.05). The morbidity, mortality and survival rates for initially unresectable liver metastases rendered to resectability were similar to those of initially resectable metastases (p>0.05). In patients with hepatic and extrahepatic metastases, the survival rate was significantly lower than in patients presenting liver only metastases (p=0.001). Complete resection of the metastases was associated with significantly longer survivals, compared with a palliative hepatectomy (p=0.039). Conclusion: Liver resection offers the chance of more than 5 years survival to 30% of patients with colorectal cancer liver metastases.

Introducere: Beneficiul rezecţiei hepatice în cazul metastazelor hepatice şi extrahepatice colorectale (MHEHCR) este încă discutabil. Scopul acestui studiu este de a evalua rezultatele rezecţiei metastazelor hepatice şi extrahepatice efectuate pacienţilor cu MHEHCR într-un centru medical cu un volum mare de intervenţii chirurgicale, atât în sfera chirurgiei hepato-biliare, cât şi în sfera chirurgiei colo-rectale şi de a identifica factorii de prognostic care se corelează cu o supravieţuire îndelungată. Metoda: Studiul este unul retrospectiv şi se bazează pe un lot de 678 de pacienţi consecutivi, cu metastaze hepatice ale cancerului colo-rectal operate într-un singur centru chirurgical, în perioada aprilie 1996 -martie 2016. Dintre aceştia, 73 de pacienţi au prezentat MHEHCR. Analiza univariată a fost efectuată pentru identificarea acelor factori de risc ce influenţează supravieţuirea generală (SG) . Rezultate: Au fost 20 de metastaze extrahepatice localizate la nivelul pediculului hepatic, 20 la nivel peritoneal, 12 la nivel ovarian şi pulmonar, 9 cu alte localizări şi 12 recidive locale. Au fost efectuate 53 de rezecţii curative (RO). Supravieţuirea Original ArticleChirurgia (2017) comparativă între lotul pacienţilor cu MHEHCR şi cel al pacienţilor cu metastaze strict hepatice a arătat o diferenţă semnificativă statistic în favoarea celui de-al doilea lot (p <0,0001), acelaşi rezultat fiind înregistrat şi în prezenţa rezecţiei R0 în cele două loturi (p <0,0001). În grupul MHEHCR, SG a fost semnificativă statistic mai mare la pacienţii care au beneficiat de rezecţie R0 faţă de cei la care rezecţia a fost R1/R2 (p = 0,004). Analiza univariată a identificat trei variabile drept factori de prognostic negativ pentru SG: 4 sau mai multe metastaze hepatice, efectuarea unei hepatectomii majore şi perioada realizării rezecţiei hepatice (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Localizarea ovariană sau pulmonară a metastazelor extrahepatice este corelată cu cea mai bună rată de supravieţuire dintre toate localizările posibile dar fară a fi semnificativă statistic. Concluzie: La pacienţii cu metastaze hepatice şi extrahepatice concomitente, rezecţia completă (R0) a acestora prelungeşte în mod semnificativ supravieţuirea. Pacienţii cu mai puţin de 4 metastaze hepatice, a căror rezecţie este realizată printr-o hepatectomie minoră sunt cei care beneficiază cel mai mult de pe urma acestei conduite terapeutice onco-chirurgicale agresive.Cuvinte cheie: metastaze hepatice ale cancerului colo-rectal, metastaze extrahepatice, metastaze hepatice şi extrahepatice ale cancerului colo-rectal, rezecţie hepatică, supravieţuire generală, factori de prognostic AbstractBackground: The benefit of hepatic resection in case of concomitant colorectal hepatic and extrahepatic metastases (CHEHMs) is still debatable. The purpose of this study is to assess the results of resection of hepatic and extrahepatic metastases in patients with CHEHMs in a high-volume center for both hepatobiliary and colorectal surgery and to identify progn...

Backgound: Several clinical risk factors for patients undergoing liver resection for colorectal liver metastases were suggested. The purpose of the study was to evaluate the prognostic factors for survival after resection of liver metastases from colorectal cancer in a high volume center for both hepatobiliary and colorectal surgery. Methods: We completed a retrospective analysis on 655 consecutive patients with liver resection for colorectal cancer metastasis operated in our centre between April 1996 and March 2016. Preoperative, intraoperative, pathologic, and outcome data for patients undergoing liver resection for metastatic colorectal were examined. Univariate analysis followed by multivariate Cox regression analysis was performed in order to identify the risk factors associated with prognostic factors related to survival. Results: There were 371 men (56.65%) and 284 women (43.35%), with a median age of 60 year-old (range 24 to 84). The primary tumor location was colon in 454 cases (69.31%) and rectum for 201 cases (30.69%). Synchronous tumors were resected in 353 cases (53.72%). The surgical mortality rate was 2.95%. The 5-year survival rate was 29.2%, and the 10-year survival rate was 17.1%. Four factors were found to be significant independent predictors of poor long-term outcome by multivariate analysis: bilobar liver metastasis (p = 0.003) with HR 1.653 (95%CI 1.180 -2.316), non-R0 resection (p < 0.001) with HR 6.066 (95%CI 3.508 -10.489), N2 lymph node stage (p = 0.007) with HR 1.528 (95%CI 1.125 -2.075) and lack of adjuvant chemotherapy (p = 0.046) with HR 1.703 (95%CI 1.009 -2.873). Conclusion:The independent prognostic factors for poor OS were both clinico-pathologic and therapeutic. In patients with good prognostic factors, an appropriate onco-surgical treatment is able to significantly prolong survival. In patients with poor prognostic factors, prognosis is mainly influenced by tumor biology and the benefit from current therapies is still modest.

Background: Limited extrahepatic disease (EHD) in patients with colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to resection. However the impact of the different sites of EHD on survival remains to be defined. Methods: Between 2000 and 2015, 702 patients underwent liver resection for CRLM at our Unit. Of these, 84 patients (11.8%) underwent resection of concomitant EHD and they are the object of our study. Results: Site of EHD was: lung in 27 patients (32.1%), hepatic pedicle lymph nodes (LN) in 38 (44.1%), peritoneum in 18 (19.0%), distant LN (inguinal and aortocaval sites) in 4 (4.8%). Sixty patients (71.4%) underwent preoperative chemotherapy (CT): 5-year overall survival (OS) after resection of CRLM and concomitant EHD was significantly higher in patients with response to CT than that in patients resected with progression (32.4% vs. 14.6%, respectively, p=0.01). Five-year OS of patients resected for liver-only CRLM was not significantly different from that of patients resected for CRLM and concomitant lung metastases (55.3% vs. 39.5%, respectively, p=ns). Resection of concomitant hepatic pedicle LN metastases was associated with a significantly lower 5-year OS (15.0%, p<0.001). Conclusion: In selected patients resection of concomitant lung metastases can be associated with similar OS to that of patients resected for liver-only disease. Presence of hepatic pedicle LN metastases is a poor prognostic factor and resection should be considered in patients showing response to CT.