Hepatic Resection for Colorectal Liver Metastases

Abstract

This report analyses an experience with 80 liver resections for metastatic colorectal carcinoma. Primary colorectal cancers had all been resected. Liver metastases were solitary in 44 patients, multiple in 36 patients, unilobar in 76 patients, and bilobar in 4 patients. Tumor size was less than 5 cm in 33 patients, 5-10 cm in 30 patients, and larger than 10 cm in 17 patients. There were 43 synchronous and 37 metachronous liver metastases with a delay of 2-70 months. The surgical procedures included more major liver resections (55 patients) than wedge resections (25 patients). Portal triad occlusion was used in most cases, and complete vascular exclusion of the liver was performed for resection of the larger tumors. In-hospital mortality rate was 5%. Three- and 5-year survival rates were 40.5% and 24.9%, respectively. None of the analysed criteria: size and number of liver metastases, delay after diagnosis of the primary cancer, Duke's stage, could differentiate long survivors from patients who did not benefit much from liver surgery due to early recurrence. Recurrences were observed in 51 patients during the study, two thirds occurring during the first year after liver surgery. Eight patients had resection of "secondary" metastases after a first liver resection: two patients for extrahepatic recurrences and six patients for liver recurrences. Encouraging results raise the question of how far agressive surgery for liver metastases should go.

Prognostic Factors for Survival after Resection of Liver Metastases from Colorectal Cancer: A Single Institution Analysis of 655 Cases

“…Currently, it is universally accepted that liver resection is associated with the highest survival rates (3,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Even in the present study the 10-year OS rate was 17.1%, similar to those already reported in the literature (10,14).…”

Hepatectomia para o tratamento de metástases colorretais e não-colorretais: análise comparativa em 30 casos operados

“…Desde então, diversas séries foram importantes para o melhor conhecimento deste tipo de procedimento, o que culminou com uma rápida expansão das indicações desta terapêutica, principalmente em virtude de seus bons resultados quando comparados ao tratamento sistêmico exclusivo (26)(27)(28)(29)(30)(31). Paralelamente, com o desenvolvimento técnico, de suporte pré e pós-operatório a mortalidade das ressecções hepáticas foram diminuindo (8).…”

“…O único caso de óbito foi em doente submetido à hepatectomia direita ampliada com ressecção do diafragma, e como já descrito por Nordingler et al (29) é fato conhecido que uma pluri-segmentectomias tem mortalidade estatisticamente maior quando comparada as ressecções menores (menos que 3 segmentos).…”

“…Dentre os mais importantes a nosso ver e que foram seguidos a risca foram: intervalo livre de doença e número de lesões. Somente foram operados doentes com lesões metacrônicas (intervalo livre de doença maior que seis meses) e de preferên-cia doentes com lesão única e no máximo quatro, isto baseado em diversos estudos que demonstraram baixa sobrevida para indivíduos com metástases sincrônicas ( 2,6,8,10,11,13,14,24,29). Fato que foi confirmado nesse estudo, onde o número de lesões (maior que uma) foi uma variável independente no prognóstico.…”

Simultaneous Hybrid Laparoscopic Rectum Extirpation and Open Liver Resection in Case of Cancer With Synchronous Distant Metastases: A Case Report

“…Высокая частота осложнений ограничи-вает возможность использования химиотерапии. По данным различных авторов, наиболее частыми из них являются осложнения со стороны легких с внутриплев-ральным выпотом -от 5 до 10 % [8], пневмония встре-чается у 20-22 % пациентов [9][10][11], желчеистечение и желчный свищ -у 4 % пациентов [9], печеночная недостаточность в 3-8 % случаев [8][9][10][11][12], гнойно-сеп-тические осложнения встречаются у 2-10 % опериро-ванных больных. Значительные кровотечения достаточ-но редки (1-3 %), но они являются наиболее частой причиной летальности [8][9][10][11][12][13][14].…”