Procedures of Choice for Resection of Primary and Recurrent Liver Metastases from Colorectal Cancer

Abstract

Although liver resection offers the only realistic chance of cure for patients with liver metastases from colorectal cancer, no consensus exists as to the procedure of choice for managing these tumors. Data from 193 patients who underwent hepatectomy for liver metastases from colorectal cancer and 26 of 193 patients who underwent repeat hepatectomy for recurrent metastases were collected. The suitability of resection was evaluated retrospectively based on known risk factors for recurrence and patterns of recurrence. On multivariate analysis, a positive surgical margin (SM+) was the only risk factor for recurrence after the initial resection (p < 0.01). SM+ (p < 0.01) and nonanatomic resection (p < 0.05) that was less than a sectionectomy (p < 0.05) were risk factors for recurrence after repeat hepatectomy. Multiple tumors (four or more) was the most common pattern of recurrence after initial hepatectomy, and recurrence close to the line of resection was most common after repeat hepatectomy. Based on tumor doubling times, recurrence after initial hepatectomy seemed to originate from the primary colorectal lesion, whereas recurrence after repeat hepatectomy was derived from a hepatic metastasis. Retrospective analysis suggests that hepatectomy with clear surgical margins is more important than anatomic resection for initial hepatectomy, and at least sectionectomy is necessary for repeat hepatectomy.

Surgical approaches of resectable synchronous colorectal liver metastases: Timing considerations

“…Martin et al [10] observed increased positive margin rate in wedge excisions and advocate anatomic hepatectomies. This view is shared by Tanaka et al [26] . Bilateral subcostal incision provides excellent liver exposure and facilitates colon resection from the cecum up to the descending colon.…”

“…Expertise in liver resections is an important factor in determining patient outcome, since the majority of postoperative morbidity and mortality are mainly related to liver surgery, a point that has been established by many studies [4,10,18,[24][25][26] . Bleeding during hepatectomy is a poor prognostic factor and all efforts should be centered at minimizing blood loss by meticulous techniques and liver vascular control [1][2][3]10,23] .…”

“…Laurent et al [25] demonstrated a clear connection of postoperative morbidity with longterm survival. Therefore, in order to optimize the surgical outcome when dealing with colorectal liver metastases, the liver surgical technique should be prioritized over the colectomy, because as mentioned before, liver surgery is related to the majority of postoperative complications and long-term survival [5,10,24,26] . Adequate exposure of the liver should be the primary concern of the surgeon in order to achieve a safe hepatectomy fulfilling the oncological principles of liver resection with a sufficient tumorfree margin [13,16,21,24,26] .…”

Surgery for colorectal liver metastases: Expanding the boundaries but where have all the patients gone

“…The liver is the most common site of recurrence and might be the only site of recurrence in about one third of those who recur. 4,[56][57][58] Repeated hepatectomy for recurrence is becoming more frequent due to early detection, new chemotherapeutic agents, accumulating experience with liver parenchyma sparing resections and due to the use of new powered instruments. Prognostic factors and surgical goals that apply to the initial liver resection for CRC metastases apply to repeat hepatectomies as well.…”

Kolorektale Lebermetastasen

“…Die Re-Resektion kann mit der gleichen Sicherheit und mit vergleichbaren 5-JahresÜberlebensraten durchgeführt werden wie die primäre Metastasenresektion. Die 5-Jahres-Überlebensraten liegen hier zwischen 23 und 49 % [193][194][195][196][197][198][199][200][201][202][203][204][205][206][207][208][209][210][211]. Auch nach Drittresektion kann ein 5-Jahres-Überleben von 32 % und ein krankheitsfreies Überleben von 17 % erreicht werden [193].…”