Preoperative Portal Embolization Research Articles

Early portal vein thrombosis after hepatectomy for perihilar cholangiocarcinoma: Incidence, risk factors, and management

To study the incidence, risk factors and management of portal vein thrombosis (PVT) after hepatectomy for perihilar cholangiocarcinoma (PHCC). Single-center retrospective analysis of 86 consecutive patients who underwent major hepatectomy for PHCC, between 2012 and 2019, with comparison of the characteristics of the groups with (PVT+) and without (PVT-) postoperative portal vein thrombosis. Seven patients (8%) presented with PVT diagnosed during the first postoperative week. Preoperative portal embolization had been performed in 71% of patients in the PVT+ group versus 34% in the PVT- group (P=0.1). Portal reconstruction was performed in 100% and 38% of PVT+ and PVT- patients, respectively (P=0.002). In view of the gravity of the clinical and/or biochemical picture, five (71%) patients underwent urgent re-operation with portal thrombectomy, one of whom died early (hemorrhagic shock after surgical treatment of PVT). Two patients had exclusively medical treatment. Complete recanalization of the portal vein was achieved in the short and medium term in the six survivors. After a mean follow-up of 21 months, there was no statistically significant difference in overall survival between the two groups. Post-hepatectomy PVT for PHCC is a not-infrequent and potentially lethal event. Rapid management, adapted to the extension of the thrombus and the severity of the thrombosis (hepatic function, signs of portal hypertension) makes it possible to limit the impact on postoperative mortality. We did not identify any modifiable risk factor. However, when it is oncologically and anatomically feasible, left±extended hepatectomy (without portal embolization) may be less risky than extended right hepatectomy, and portal vein resection should only be performed if there is strong suspicion of tumor invasion.

Therapeutic plasma exchange as an effective salvage measure for post-hepatectomy hepatic failure: A case report

Major hepatectomy can result in post-hepatectomy hepatic failure (PHHF) and therapeutic plasma exchange (TPE) can be used as a salvage procedure for liver support. We herein present a case of 69-year-old male patient with perihilar cholangiocarcinoma who was successfully managed with salvage TPE. Preoperative portal embolization was performed to reduce the parenchymal resection rate. The extent of surgery was right hepatectomy with partial excision of the ventral portion of the segment IV, caudate lobectomy, bile duct resection and extensive lymph node dissection. No noticeable surgical complications occurred after the operation, but serum total bilirubin level increased gradually and reached 10 mg/dL at 1 month after the operation. At postoperative day 38, total bilirubin level raised to 19.8 mg/dL and prothrombin time deteriorated significantly, thus salvage TPE was started. TPE was performed three times per week for 2 weeks; consequently, the total bilirubin level was maintained below 10 mg/dL. A few days later, a rebound of total bilirubin occurred; accordingly, 2 sessions of TPE were performed additionally. Overall, a total of 8 sessions of TPE were performed. The patient was discharged at 84 days after operation. The total bilirubin level returned to normal at 5 months after operation. This patient is doing well for past 9 months. In Korea, TPE for liver support has been approved by the social health insurance since August 2020. In conclusion, salvage TPE is an effective liver support measure for PHHF, thus we suggest starting TPE if serum total bilirubin level reaches 10 mg/dL after hepatectomy.

3D laparoscopic anatomical segment 8 resection for colorectal liver metastasis recurrence after previous left hemi-hepatectomy

Purpose: Patients suffering from colorectal liver metastasis (CRLM) often have recurrent disease and many patients will undergo multiple surgical procedures during the course of their disease. Redo hepatic surgery can be notoriously difficult. In this video we will show a case of 3d laparoscopic anatomical segment 8 resection after previous left hemi-hepatectomy for CRLM. Method: This 75 year old patient had a local recurrence of a metastasis of her colon cancer (pT2N0, 2014) at the previous resection plane after left hemi-hepatectomy (2019, R1). The recurrence was in contact with the right anterior pedicle. The patient had stable disease after 10 cycles of chemotherapy (Folfox- Bevacizumab) and was considered for surgery. Preoperative calculation of FLR for segment 5/8 resection showed a 34% FLR. Extensive chemotherapy was administered preoperatively suggesting chemotherapy induced liver injury. A pre-operative portal embolization of P8 was performed to induce hypertrophy of the FLR. CT scan 6 weeks after embolization showed no apparent hypertrophy in S6/7. Results: A 3D laparoscopic anatomical S8 resection was performed. Segment 5 could be preserved by selective transection of S8 pedicle. Operation and peri-operative course were uneventful. Operative time of 3hours, estimated blood loss of 250ml. No postoperative liver insufficiency. TOSGS 0, patient went home POD 3. Conclusion: Laparoscopic redo hepatic surgery after previous major hepatectomy is technically challenging, but can safely be performed with low morbidity and good oncological outcomes.

Abstract No. 645 Preoperative percutaneous transhepatic portal vein embolization in biliary malignancy: hepatic hypertrophy and posthepatectomy liver failure

Abstract No. 645 Preoperative percutaneous transhepatic portal vein embolization in biliary malignancy: hepatic hypertrophy and posthepatectomy liver failure

Locally advanced gallbladder cancer: Contemporary outcomes for aggressive surgical management.

420 Background: Patients with gallbladder cancer (GBCA) often present at advanced stages and their prognosis is dismal. Surgery for locally advanced (LA) disease has been controversial and the optimal indication for resection needs to be defined. Methods: Patients who underwent curative resection for GBCA of T1b or greater with curative intent at our institution from Jan. 2006 through Jun. 2017 were included. “Locally advanced disease” was defined as GBCA deemed to invade the hepatic hilum, or the extrahepatic organs either by the preoperative imaging. Perioperative management, operative procedures, and the short- and long-term for the patients with LA-GBCA were evaluated and compared with those for the patients with localized GBCA (L-GBCA). Results: Total 102 patients were identified and 35 patients were with LA-GBCA. Nineteen patients (54%) with LA-GBCA presented with jaundice, and all of them had biliary stent placed preoperatively. Preoperative portal embolization was performed for 22 patients (63%). Extended resections included hepatopancreaticoduodenectomy (n = 14, 40%), major hepatectomy (lobectomy or greater, n = 29, 83%), with partial duodenectomy (n = 7, 20%), with partial colectomy (n = 6, 17%), and with major vascular resection/reconstruction (n = 9, 26%). R0 resection was achieved in 87% of the patients with LA-GBCA by extended resection, while it was achieved in 91% of those with L-GBCA by standard radical cholecystectomy ( p= 0.13). The 5-year recurrence-free and overall survival (RFS and OS) rates for the patients with LA-GBCA were 19% and 26%, compared with 57% and 66% for those with L-GBCA ( p< 0.001 for RFS, and p < 0.001 for OS, respectively). In the multivariate analysis for all the patients with GBCA, T3 or greater, nodal metastasis and R1 resection remained as significant risk factors for both recurrence and death after resection with curative intent. Conclusions: Although extended resection for locally advanced cancer is safe and feasible, its long-term outcomes remained poor. Appropriate patient selection criteria needs be established to avoid aggressive operation without benefit for the patients with LA-GBCA.

Extreme liver surgery as treatment of liver tumors involving the hepatocaval confluence.

Analyze the characteristics, surgical technique, morbidity and survival of patients treated with extreme liver surgery. We present a series of consecutive patients with malignant liver tumors in hepatocaval confluence treated in a single center with extreme liver surgery (April 2008-March 2015). Data were collected prospectively and analyzed with SPSS 21.0. 12 patients were included. 50% were male and 50% were female with a mean age of 59±10years old. The median of comorbidities was 7 according to the Charlson Age Comorbidity Index. The 75% of the tumors were metastases, most of them from colorectal cancer. Most of the patients received neoadjuvant chemotherapy and in 58% preoperative portal embolization was performed. Major hepatectomies were performed (66.7% extended right hepatectomy, 33.3% left extended hepatectomy). The 83.3% of the patients needed vascular reconstruction. Postoperative morbidity was more than grade II in 50% of the patients according to Dindo-Clavien classification. There was no intraoperative mortality. The postoperative mortality rate at 90days was 33% due to hepatic failure and biliary fistula. In December 2015, 33% of the patients are still alive with a mean survival of 19months (13-23) with an ECOG Performance Status of 0. Extreme liver surgery carries a high rate of morbidity and mortality that seem to increase with age and with higher tumor volumes, according to the literature. It is a therapeutic option to consider in patients with low comorbidity suffering from malignant neoplasms that involve the hepatocaval confluence, when no other treatment with curative intention can be performed.

First results of radical and conditionally radical resections for Klatskin tumors

Relevance : Hilar cholangiocarcinoma is the most common malignant tumor of the bile ducts. Aim : analysis of the first experience of radical and conditionally radical operations performed in MCSC during one year. Materials and methods : Extended hepatectomies combined with resection of bile ducts and first segment performed in 18 patients with Klatskin tumor. Right hemihepatectomy performed in 8 patients, resection with caudal lobectomy – in 8 patients. The preoperative percutaneous right-sided selective portal embolisation using Celonova microspheres was performed in 5 patients. One patient with type II tumor according to Bismuth-Corlette classification underwent hemihepatectomy with a left caudal lobectomy and resection of the extrahepatic bile ducts using laparoscopic approach and DaVinci robotic system. Results : The average volume of intraoperative blood loss was 705±616 ml (range 200 to 2000 ml). Postoperative III and IV grade complications according to Clavien-Dindo classification occurred in 13 patients (72%). Two patients (11%) died postoperatively. The cause of death in both observations was severe sepsis. Patients with R1 and R2-resections undergo adjuvant chemotherapy with no objective signs of progression. Patients with R0-resection are under observation with no signs of progression. Conclusion : Late diagnosis, a high risk of postoperative complications requires a multidisciplinary approach at each stage of the treatment of Klatskin tumor.

Granulomatous Phlebitis of the Hepatic Vein Tributaries after Portal Venous Embolization

Background & Aims: Granulomatous phlebitis of hepatic vein is a rare disease and its exact etiopathogenesis remains unknown. Recently, we experienced granulomatous phlebitis of small hepatic veins in a patient who underwent hepatic resection for metastatic liver cancer after preoperative portal venous embolization (PVE). Methods: We surveyed such phlebitis in the patients who underwent PVE (2008 August – 2014 August). A total of 62 patients underwent PVE followed by hepatectomy for hepatocellular carcinoma (HCC), peripheral cholangicarcinoma (pCCA), or metastatic liver tumor (MLT) during this period. As a control, 20 cases of surgically resected livers without a history of preoperative PVE for liver tumors of comparable age and sex distribution in recent 2 years in the same hospital, were used. Results: Granulomatous phlebitis of small hepatic veins was found in 10 patients with a history of PVE (16.1% of 62 cases) but not in control cases. No microbial agents were identified in these granulomatous lesions. Interestingly, the presence of embolic materials containing sponge gel with inflammation and foreign body reaction in the portal veins in the embolized livers were independently associated with granulomatous phlebitis. Conclusions: It was suggested that sponge gel used for PVE might have be directly or indirectly related to the occurrence of granulomatous phlebitis. This is the first report of granulomatous phlebitis related to PVE.

Cholangiocarcinoma — Current Treatment Options

The treatment for cholangiocarcinoma (CCA) remains a challenge because of the aggressive nature of the disease and the absence of effective treatments besides surgical resection (HR) and liver transplantation (LT). In intrahepatic CCA, HR remains the treatment of choice whereas with concomitant liver disease such as cirrhosis or primary sclerosing cholangitis (PSC), LT is the only option. Hilar CCA or Klatskin tumours have in recent decades been managed with a more aggressive surgical approach to achieve R0 resection. This approach usually involves preoperative portal embolisation, followed by liver resection – sometimes extensive and even with portal vein resection. The recent protocols that combine preoperative neoadjuvant chemoirridation and LT show promising results that need to be confirmed. The development of diagnostic modalities (tumour markers, cytology and radiology) are of the utmost importance to identify these patients at an early stage to preserve radical surgery possible. Cholangiocarcinoma (CCA) is a malignant disease of the epithelial cells in the intra- and extrahepatic bile ducts. While still a rare malignant disease, CCA is the second most common primary malignancy of the liver. The incidence is increasing; especially the incidence of intrahepatic CCA (1). The treatment of CCA is challenging as it is usually difficult to diagnose when radical surgical treatment, resection (HR) or liver transplantation (LT) is possible. The lack of effective medical treatment makes a radical surgical resection or hepatectomy the only therapeutic option. Most of the CCAs are unresectable at presentation and the prognosis for these patients is dismal.

Preoperative Portal Venous and Hepatic Arterial Embolization of Tumor

Although the goal of embolization is usually to create therapeutic ischemia or hemostasis without surgery, the rationale for preoperative embolotherapy is different in several respects. First, the aim is to prepare patients for definitive surgical resection rather than cure or palliation, and, thus, the goals and expectations are limited and defined by close communication between the interventionalist and the surgeon. Second, when considering segmental resection, the normal liver should be protected from procedural damage. Third, the search for extrahepatic disease is crucial for these patients because resection is typically abandoned in favor of alternative therapies for patients with systemic disease. Finally, intraoperative ultrasound should always be considered to survey the future liver remnant for unsuspected small tumors and allow ablation of these lesions to maximize the success of partial hepatectomy. This article describes preoperative hepatic arterial and portal venous embolization in patients with or without cirrhosis complicated by tumors judged eligible for surgical resection or orthotopic liver transplantation (OLT). Each type of embolization will be reviewed in terms of indications and contraindications, technique, and complications. Finally, the outcomes will be evaluated in terms of morbidity, mortality, and tumor recurrence rates.

Preoperative assessment of hilar cholangiocarcinoma using multidetector-row CT: correlation with histopathological findings

Our aim was to investigate the diagnostic reliability of multidetector-row computed tomography (MDCT) for preoperative assessment of local tumoral spread in hilar cholangiocarcinoma. MATEIRALS AND METHODS: Thirteen of 30 consecutive patients with hilar cholangiocarcinoma who underwent surgery, excluding 17 patients who underwent biliary drainage or preoperative portal embolization, were retrospectively evaluated. Using MDCT systems of 4 detector rows or 16 detector rows, plain and dynamic contrast-enhanced images of three phases were obtained. Extent of tumor spread and lymph node metastasis were assessed with MDCT and compared with histopathological findings. The Bismuth-Corlette classification of hilar cholangiocarcinoma with MDCT were type I, 1 patient; type IIIa, 3 patients; type IIIb, 4 patients; and type IV, 5 patients; those with histopathological findings were type I, 1 patient; type IIIa, 2 patients; type IIIb, 4 patients; and type IV, 6 patients. One patient diagnosed as type IIIa with MDCT was pathologically diagnosed as type IV. Accuracy of MDCT in tumoral spread was 92.3%, although that of lymph node metastasis was 54%. MDCT is likely to play an important role in evaluation of focal lesion spread especially in intrapancreatic tumor invasion, although a greater number of cohort cases are necessary to clearly define its role.

Sequential Preoperative Ipsilateral Portal and Arterial Embolization in Patients with Liver Tumors: Is It Really the Best Approach?

Sequential Preoperative Ipsilateral Portal and Arterial Embolization in Patients with Liver Tumors: Is It Really the Best Approach?

Sequential Preoperative Ipsilateral Portal and Arterial Embolization in Patients with Colorectal Liver Metastases

Preoperative portal vein embolization (PVE) induces ipsilateral atrophy of the hepatic parenchyma to be resected, as well as contralateral compensatory hypertrophy of the residual liver. However, there are two potential problems with this technique: inadequate contralateral hypertrophy and tumor progression while waiting for the non-embolized liver to hypertrophy. We devised a strategy to deal with these two problems by performing an ipsilateral hepatic artery embolization 6 weeks after an unsatisfactory PVE in an effort to accelerate the hypertrophy of the remnant liver. Two patients with colorectal liver metastases underwent to this sequential preoperative treatment in order to achieve resectability of their metastatic disease. Both patients successfully underwent major hepatic resection. In our experience sequential ipsilateral portal vein and hepatic artery embolization extended the indications for liver resection for metastatic colorectal cancer.

Safety and Effectiveness of Left Hepatic Trisegmentectomy for Hilar Cholangiocarcinoma

Left hepatic trisegmentectomy has been performed for huge malignant tumors, but it is rarely applied in patients with hilar cholangiocarcinoma. Twelve consecutive patients (7 men and 5 women; mean age, 64 years) underwent left hepatic trisegmentectomy in our institution between January 2000 and December 2003. The preoperative management and postoperative outcomes of this surgical procedure were presented and retrospectively analyzed. Preoperative biliary drainage and portal vein embolization were performed in 6 patients (50%) and 9 patients (75%), respectively. The preoperative estimated volume ratio of the posterior segment /the whole liver was 44.8 +/- 7.0% (34.3-54.3), the plasma retention rate of indocyanine green at 15 minutes was 8.6 +/- 2.2% (4.7-13.7), and the serum total bilirubin level before surgery was 1.0 +/- 0.4 mg/dl (0.4-1.7). The serum total bilirubin level on the first postoperative day was 3.3 +/- 0.4 mg/dl (1.4-6.2). There was no hospital death or postoperative hepatic failure. The incidence of positive resectional margin was 25%. With biliary decompression and preoperative portal embolization techniques, left hepatic trisegmentectomy was a safe and curative resectional option for hilar cholangiocarcinoma.

Safe and permissible limits of hepatectomy in obstructive jaundice patients.

The safe and permissible limits of hepatectomy in obstructive jaundice patients and the usefulness of preoperative portal embolization (PE) for increasing the limit for safe hepatectomy were examined. We classified 416 patients with hepatectomy performed over 9 years under the following headings: normal liver function (n = 242); chronic hepatitis (n = 71); liver cirrhosis (n = 64); and liver after relief of obstructive jaundice (n = 39). Hepatectomy was done after the total bilirubin level was reduced below 3 mg/dl by preoperative biliary drainage. Factors influencing the maximum total bilirubin level measured within 2 weeks after hepatectomy were investigated, and this level was taken to reflect the degree of surgical stress. PE was carried out in 18 patients with obstructive jaundice. The maximum total bilirubin, expressed as a logarithm, was significantly correlated with the percent of liver resected in all groups. Hepatectomy followed by a maximum total bilirubin of less than 8.5 mg/dl was accepted as safe, and hepatectomy followed by a bilirubin level of 14.4 mg/dl was deemed the maximum permissible resection. On the basis of these results, the safe and permissible limits of hepatectomy in patients with obstructive jaundice were 48.7% and 71.6%, respectively. PE decreased the maximum total bilirubin from 8.5 mg/dl to 3.9 mg/dl when 48.7% of the liver (a safe proportion in all cases) was resected; PE increased the safe limit of hepatectomy from 48.7% to 67.4% when a maximum posthepatectomy total bilirubin level of 8.5 mg/dl was accepted as safe.

Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate.

To demonstrate our strategy for hilar bile duct cancer and to elucidate prognostic factors and the surgeon's role in long-term survival. Extended hemihepatectomy is recognized as a curative treatment of hilar bile duct cancer but is not always safe because of the risk of postoperative liver failure. A safe and beneficial strategy is required. Fifty-eight consecutive major hepatectomies for hilar bile duct cancer were reviewed retrospectively. Appropriate preoperative treatments, biliary drainage, and portal embolization were performed before major hepatectomies. The short- and long-term results of our strategy are presented and analyzed. Biliary drainage and portal embolization were performed in 39 patients (67.2%) and 31 patients (53.4%), respectively. Major hepatectomies comprised 27 extended right and 22 extended left hemihepatectomies and 9 hepatoduodenopancreatectomies. Operative morbidity and mortality rates were 43% and 0%, respectively. There was no postoperative liver failure. The overall 5-year survival rate was 40%. Univariate analysis showed that residual tumor status, lymph node involvement, and perineural invasion were associated with patients' long-term survival. A surgical margin over 5 mm resulted in better long-term survival. The delay resulting from preoperative treatment was not detrimental to long-term survival. Multivariate analysis showed that lymph node involvement was the only prognostic factor. Our strategy, which includes preoperative biliary drainage and portal embolization, led to a reduction in the risks associated with major hepatectomy for hilar bile duct cancer, and resulted in zero mortality. Surgeons should aim at complete clearance of the tumor with an adequate surgical margin to ensure optimal long-term survival.

Evaluation of preoperative portal embolization for safe hepatectomy, with special reference to assessment of nonembolized lobe function with 99mTc-GSA SPECT scintigraphy

Background. Preoperative portal embolization (PE) is used to stimulate liver hypertrophy in the nonembolized lobe. We studied liver volume and function with computed tomography and technetium-99m-galactosyl human serum albumin (99mTc-GSA) scintigraphy before PE and at 1 or 2 weeks after PE. Methods. Right PE was performed in 30 patients. Morphologic and functional hypertrophy in the left lobe after PE was determined and related to the presence or absence of cholestasis, biliary drainage of the embolized lobe, and postoperative liver failure. Results. The volume of the left lobe and 99mTc-GSA uptake increased rapidly for the first week after PE, but no significant increase was seen during the second week. Morphologic hypertrophy was less pronounced in patients with jaundice (P =.03). When PE was performed at a total bilirubin level above 2 mg/dL, the interval between PE and surgery was prolonged because of cholangitis and liver abscess formation. The net morphologic hypertrophy ratio was significantly higher in livers that had undergone left lobe drainage only (9.1% ± 0.9%) compared with those in which there was drainage of the embolized lobes (5.7% ± 0.9%; P =.03). The volume and 99mTc-GSA uptake of the left lobe in the second week after PE was significantly smaller in patients with postoperative liver failure (33.7% ± 2.4% and 18.0% ± 2.1%, respectively) than in patients without liver failure (46.2% ± 1.4% and 38.4% ± 2.3%; P =.003 and P =.01, respectively). Conclusion. In the nonembolized lobe, the functional increase in 99mTc-GSA uptake is more pronounced than suggested by the degree of morphologic hypertrophy. Whenever possible, biliary drainage should not be performed in the lobe undergoing hepatectomy. 99mTc-GSA SPECT scintigraphy is useful for the evaluation of postoperative liver failure. (Surgery 2003;133:495-506.)

Changes in functional capacity after portal branch ligation in rats.

Preoperative portal branch embolization is performed to increase residual liver lobe volume so that posthepatectomy liver insufficiency associated with major hepatic resection can be prevented. Although it is essential to evaluate functional liver capacity after portal branch embolization. the timing of hepatectomy from this viewpoint remains unelucidated. The aim of this study was to clarify the optimal timing of hepatectomy after portal branch embolization. We evaluated the functional capacity of the liver after portal branch ligation (PBL) in rats, and studied the correlation between morphological and functional changes. Morphological changes were evaluated on the basis of the liver lobe weight ratio, and the proliferating cell nuclear antigen labeling index. Functional changes were evaluated by the indocyanine green disappearance rate and serum aminopyrine clearance as functional capacity. Although the total liver weight ratio remained unchanged after PBL, the unembolized lobe ratio increased significantly. Although functional capacity was minimal 2 days after PBL, it had recovered to the preoperative value by 8 days after PBL. The functional capacity of the liver after PBL was minimal around the cellular proliferative period but recovered thereafter. These findings suggest that major hepatectomy after portal branch embolization should be perfomed following the cellular proliferative period of the unembolized lobe.

Preoperative portal embolization for induction of liver hypertrophy

Preoperative portal embolization (PVE) is now widely used to induce hypertrophy of the anticipated liver remnant. Here, pathophysiology, indications, technical procedures, and problems of PVE are reviewed and our experience of 105 PVEs is presented. The reported complication rate after PVE is low (0-10%) and the increment of the future remnant liver volume is 12% of total liver volume (range: 7-27%). The resection rate after PVE ranged from 58% to 100%. In our series of 105 PVEs, the morbidity rate was 3.8%, the future remnant liver increased by about 10% of total liver volume, and 34 patients (32.4%) did not undergo planned extended hepatectomy. After hepatectomy, hepatic failure occurred in one patient (< 1%). In conclusion, although PVE is a safe procedure for enlarging the future remnant liver, more appropriate indication criteria should be established.

Hepatic metastases of gastroenteropancreatic neuroendocrine tumors: safe hepatic surgery.

Liver metastases of neuroendocrine tumors are usually slow-growing, and cytoreductive hepatectomy can help reduce the effects of endocrinopathies and increase life expectancy and symptom-free survival. However, it has yet to be fully investigated how hepatectomy for metastatic neuroendocrine tumors can be performed safely. Here we report the results of 13 patients with neuroendocrine liver metastases operated on in our institution and those of a French multicentric study that included 131 patients. Preoperative patient selection and appropriate surgical technique, sometimes combined with preoperative portal embolization and local tumor destruction (radiofrequency and cryotherapy), may increase the resectability and the safety of the procedure. The mortality rate after hepatectomy was 0% (2.3% in the French study); the 3- and 6-year survival rates were 91% and 68%, respectively, in our institution (the mean survival time was 66 months in the French multicentric survey). Significant prolonged survival with complete palliation of symptoms can be obtained after liver metastases resection with low mortality.