Modern surgery for liver metastases

Abstract

Patients with hepatic metastases from colorectal cancer have a poor prognosis, with a median survival of less than 12 months. Although chemotherapy may have a beneficial effect on the natural history of unresected liver metastases, 5-year survival is difficult to achieve by chemotherapy alone. Hepatic resection can achieve prolonged survival with an acceptable mortality risk in selected patients, but this approach has classically been reserved for a very select group of patients, usually those with a solitary metastasis discovered some time after the primary colorectal resection. This author’s practices in surgery for hepatic metastases from colorectal cancer have been more radical than most other surgeons[1]. A careful follow-up protocol with the use of adjuvant chemotherapy and redo resection have enabled this author to achieve satisfactory results (Figs ​(Figs11 and ​and22). Figure 1 48% 5-year survival from hepatic resection ( n =161). Figure 2 58% for bilateral resection ( n =97); 35% for unilobar disease ( n =64) at 5 years ( p > 0.05). This demonstrates that patients with advanced disease can do well. Thus, these days it seems that virtually no liver tumour should be considered to be unresectable, even though the majority of patients continue to present at a late stage in their disease. Some experts have challenged the old dogma relating to hepatic resection and candidates with multiple and bilobar tumours, as well as patients with limited extrahepatic infiltration, are now considered for resection. In addition, metastases from tumours other than colorectal cancer are also regularly undergoing liver resection.