The extent of resection influences outcome following hepatectomy for colorectal liver metastases

Abstract

Background. The acceptable indications for liver resection in patients with colorectal metastases have increased significantly in the last decade. It is thus becoming more difficult to ascertain the limitations for selection as the boundaries have been greatly extended. This has resulted in not only more extensive resections, but more atypical and bilobar resections. The aim of this study was to compare the outcome of patients undergoing different extent of liver resection in a specialist unit. Methods. All patients undergoing liver resection for colorectal metastases at the Royal Infirmary of Edinburgh between October 1988 and April 2001 were reviewed. Patients were allocated into one of three groups: standard group, extended group, and segmental group. Patient information was collected from a prospectively completed database. Results. One hundred and thirty-seven patients had liver resections for colorectal metastases during the study period. There were 69 standard hepatectomies, 41 extended resections and 27 segmental resections. CEA level was significantly lower in the segmental group ( p=0.012). There was a significant difference between the groups in terms of median operating time ( p<0.0001, Kruskal–Wallis test), operative blood loss ( p=0.006, Kruskal–Wallis test) and post-operative stay ( p=0.036, Kruskal–Wallis test). Major post-operative complications were similar between standard and extended resections but less following segmental resection ( p=0.050). Predicted median survival was 51 months following standard resection, 23 months following extended resection and 59 months after segmental resection ( p=0.037, log rank test), however, there was no difference between the three groups for actual 5-year survival ( p=0.662, Pearson chi-square test). Conclusion. Morbidity and mortality rates were comparable with other previous studies as was overall survival, although survival in patients undergoing extended resections was reduced. There was an acceptable level of morbidity and mortality for all three groups. Patients undergoing segmental resection had fewer complications, shorter length of stay, and the longest median survival suggesting adequate oncological clearance. Segmental resection has a role for favourably placed tumour deposits if oncological clearance can be ensured. Extended liver resections have a role for selected patients with bilobar colorectal metastases or large solitary deposits close to the hepatic vein confluence.