Results of surgical therapy of bilateral colorectal liver metastases

Abstract

Background: Surgery of colorectal liver metastases (CLM) may offer prolonged survival or even cure in resectable patients. However, bilateral CLM often require extended or multi-step resections to achieve complete tumor removal. Methods: Between 2000 and 2016, 152 patients were scheduled for potentially curative resection of bilateral CLM. Among these, 130 patients (85.5%) completed surgery whereas 22 (14.5%) developed irresectable disease during planned multi-step procedure. Of the 130 patients analyzed, 105 underwent single-step surgery: 55 major resections (38 of those with additional wedge resections) and 50 multiple wedge resections. The remaining 25 patients underwent multi-step resections. Portal vein embolization was performed in 26%, intraoperative additional RFTA in 24% of all patients. Results: Postoperative mortality was 0.8%. Free margins were achieved in 83%. 5-year survival was 34% in the entire group. In univariate survival analysis, positive margins, CLM > 30 mm, more than 3 CLM, age and colonic primaries were significantly associated with worse survival. In multivariate survival analysis, the resection margin, size and number of metastases and age were independent predictors of survival. Conclusion: Extended surgery of bilateral CLM provides acceptable OS and is associated with a low mortality. In our cohort, resection margin, size and number of metastases and age were independent predictors of survival.