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Langenbecks Arch Surg. 2004 Apr;389(2):114-21. Epub 2004 Jan 9.

Results of surgical treatment for multiple (> or =5 nodules) bi-lobar hepatic metastases from colorectal cancer.

Author information

1
Department of Surgery II, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004 Yokohama, Japan. hs440312@med.yokohama-cu.ac.jp

Abstract

BACKGROUND:

The surgery for the treatment of multiple (> or =5) bi-lobar hepatic metastases from colorectal cancer is controversial. This retrospective study presents our experience in an attempt to develop reasonable treatment guidelines.

METHOD:

One hundred sixty-one consecutive patients who underwent liver resection with curative intent were classified into three groups: H1 (unilateral), H2 (bilateral, < or =4 nodules), or H3 (bilateral, > or =5 nodules).

RESULTS:

The overall cumulative 5-year survival rate was 46.7%. Survival was similar among patients with H1, H2, and H3 disease. Thirty-two patients with H3 disease underwent hepatectomy: straightforward hepatectomy in 12, portal vein embolization (PVE) prior to hepatectomy in eight, two-stage hepatectomy in two, and two-stage hepatectomy combined with PVE in ten. Two-stage hepatectomy with or without PVE was the standard approach in patients with synchronous liver metastases. The operating mortality in hepatectomy for H3 disease was 0%, and the morbidity was 15.2%. The overall response rate to neoadjuvant chemotherapy (NAC) was 41.7% (5/12). Patients who responded to NAC (n=5) had a better prognosis than non-responders (n=7) ( P<0.05).

CONCLUSIONS:

Extended hepatectomy, including preoperative PVE and multi-step hepatectomy, combined with NAC, may result in a favourable prognosis, especially in patients who respond to NAC, but further studies with more patients are needed to confirm this.

PMID:
14714186
DOI:
10.1007/s00423-003-0447-6
[Indexed for MEDLINE]

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