Synchronous Hepatic Metastases Research Articles

Clinicopathological analysis of synchronous liver metastasis in gastric cancer and evaluation of surgical outcomes

To analyze the clinicopathological factors affecting synchronous liver metastasis in gastric cancer,and evaluate its surgical outcome. Clinical data of 44 patients with synchronous hepatic metastasis from gastric cancer from Aug. 1994 to Feb. 2004 were reviewed retrospectively, and compared with those of 576 gastric cancer patients without hepatic metastasis to analyze the clinicopathological factors affecting synchronous liver metastasis from gastric cancer. The survivals after radical resection, palliative and exploratory operation were compared. Univariate analysis revealed that ascites, pelvic and peritoneal seeding, serosal invasion, lymph node metastasis, involvement of neighboring organs, Borrmann types,depth of infiltration were correlated with synchronous hepatic metastasis from gastric cancer (P< 0.01). Logistic regression showed peritoneal seeding (P=0.003, OR=1.629), serosal infiltration (P=0.000, OR=3.000), lymph node metastasis (P=0.081, OR=1.689) were independent risk factors for synchronous hepatic metastasis from gastric cancer. Sixteen (36.4%) patients received radical excision, 15 (34.1%) patients palliative operation, and 13 (29.5 %) patients exploratory operation,and the median survival times were 19.5, 11.0 and 6.2 months respectively (P< 0.05). Peritoneal seeding,serosal infiltration, lymph node metastasis are most important risk factors for synchronous hepatic metastasis from gastric cancer. Radical resection of gastric primary lesion and hepatic metastases can significantly prolong survival time.

Expressing the Surgery First Position on Treatment of Synchronous Colorectal Metastases in the Asymptomatic Patient

The patient is asymptomatic with synchronous hepatic metastases from a colorectal primary tumor. The options for treatment would be to resect the colorectal primary tumor and treat the liver metastases or to give chemotherapy first and then see if resection is feasible. The ultimate goal of every cancer surgeon is to cure the patient. For the vast majority of patients with metastatic disease, this is impossible. In those situations, surgery must be used as a palliative tool; thus, extirpative surgery is generally not needed in the asymptomatic patient, especially with the advent of new chemotherapy agents that have such good response rates in patients with colorectal cancer. However, in the patient with synchronous liver metastases only, there remains a chance for cure, and that chance should always be pursued. New data about hepatic artery infusions in the face of unresectable liver metastases show extremely high response rates in the liver and make the chance of converting patients disease into resectable lesions a possible reality. Thus, in a patient who is capable of undergoing surgery and who has a primary colorectal cancer and liver metastases only, the best treatment would be a resection of the primary cancer and placement of a hepatic artery infusion pump for unresectable disease or resection of the liver metastases and placement of a hepatic artery infusion pump. Treatment with systemic chemotherapy before surgery would not help the situation and may allow potentially curable disease to become too large for resection. Synchronous hepatic metastases from colorectal primary tumors occur in approximately 20% of patients with colorectal cancer. The question of operability of the hepatic lesions does not hinge on whether or not the metastases are synchronous. Because patients with synchronous disease can also have 5-year survivals of >25%, they should not be excluded from hepatic resection. The important factors for assessing whether colorectal metastases are resectable have been assessed by two groups with large retrospective studies. Both of these groups were addressing patients with metastases confined to the liver, and thus patients with portal lymph nodes involved with tumor, with carcinomatosis, or with lung or other organ metastases were not considered good candidates for hepatic resection. One of the systems was developed by Dr. Yuman Fong at Memorial Sloan-Kettering Cancer Center and included five clinical criteria. They were (1) the nodal status of the primary tumor, (2) the disease-free interval from the time of the primary operation to discovery of liver metastases (£12 or >12 months), (3) more than one tumor, (4) a preoperative carcinoembryonic antigen level >200 ng/mL, and (5) largest tumor >5 cm. Each negative criterion was assigned one point, and the 5-year survivals were calculated. For patients with a score of 0, the 5-year survival was 60%, compared with 14% for those with Received July 27, 2005; accepted October 24, 2005; published online January 16, 2006. Address correspondence and reprint requests to: M. Margaret Kemeny, MD, FACS; E-mail: kemenym@nychhc.org

Proposal of criteria to select candidates with colorectal liver metastases for hepatic resection: Comparison of our scoring system to the positive number of risk factors

To select accurately good candidates of hepatic resection for colorectal liver metastasis. Thirteen clinicopathological features, which were recognized only before or during surgery, were selected retrospectively in 81 consecutive patients in one hospital (Group I). These features were entered into a multivariate analysis to determine independent and significant variables affecting long-term prognosis after hepatectomy. Using selected variables, we created a scoring formula to classify patients with colorectal liver metastases to select good candidates for hepatic resection. The usefulness of the new scoring system was examined in a series of 92 patients from another hospital (Group II), comparing the number of selected variables. Among 81 patients of Group I, multivariate analysis, i.e. Cox regression analysis, showed that multiple tumors, the largest tumor greater than 5 cm in diameter, and resectable extrahepatic metastases were significant and independent prognostic factors for poor survival after hepatectomy (P < 0.05). In addition, these three factors: serosa invasion, local lymph node metastases of primary cancers, and post-operative disease free interval less than 1 year including synchronous hepatic metastasis, were not significant, however, they were selected by a stepwise method of Cox regression analysis (0.05 < P < 0.20). Using these six variables, we created a new scoring formula to classify patients with colorectal liver metastases. Finally, our new scoring system not only classified patients in Group I very well, but also that in Group II, according to long-term outcomes after hepatic resection. The positive number of these six variables also classified them well. Both, our new scoring system and the positive number of significant prognostic factors are useful to classify patients with colorectal liver metastases in the preoperative selection of good candidates for hepatic resection.

Factors affecting survival in patients presenting with synchronous hepatic metastases from colorectal cancer: a clinical and computer analysis.

A review of 90 patients presenting in Leeds over the period 1976-80 with synchronous hepatic metastases from colorectal cancer has been undertaken. The median survival for the group was 10.3 months (range 1-48 months). A multivariate analysis identified factors in the history and examination of the patient, results of biochemical and haematological investigations and characteristics of both the primary and secondary tumour, which influenced survival. Recognition of these factors allowed both a clinical scoring index and computer survival model to be constructed. When applied to the group as a whole both were reasonably accurate at predicting survival (62 per cent for the survival model and 66 per cent for the scoring index). However, the computer model correctly identified 80 per cent of the 'long-term' survivors (greater than 12 months from the time of diagnosis). It is concluded that many trials of therapy for hepatic metastases from colorectal cancer have failed to consider the natural history of the disease and the identification of prognostic indices should allow for adequate stratification within the treatment arms of any future study.

Outcome of Hepatic Resection for Metastatic Gastric Cancer

The role of hepatic resection for metastatic gastric cancer is less well defined due to the tendency of gastric cancer to widely metastasize. The purpose of this study is to examine the beneficial effect of hepatic resection in patients with metastatic gastric cancer. The clinicopathologic features and long-term results of 11 patients who underwent hepatic resection for metastatic gastric cancer from January 1988 to December 1996 at Seoul National University Hospital were analyzed retrospectively. All resected hepatic metastases were solitary lesions. Among eight patients with synchronous hepatic metastases, one patient with early gastric cancer and lymph node metastases (T1N2M1) remained alive for 8 years 6 months after hepatic resection without recurrence. Among three patients with metachronous hepatic metastases, two patients with advanced gastric cancer and lymph node metastases (T3N2MO, T2N1MO at the initial operation, respectively) survived 8 years 6 months and 3 years after hepatic resection, respectively. Median survival times of synchronous and metachronous hepatic metastases were 13.0 and 74.3 months, respectively. In solitary hepatic metastatic lesions from gastric cancer, surgical resection should be considered as one of the treatment options.

Surgical treatment of hepatic metastatic tumor from gastric cancer

To assess the long- term efficacy of surgical treatment of hepatic metastases from gastric adenocarcinoma. Clinical data of 938 cases with primary gastric cancer from January 1993 to October 2001 were analyzed retrospectively. Thirty- two cases received resection of hepatic metastases from gastric adenocarcinoma. Metachronous hepatic metastasis occurred in 24 cases(2.6% ),and 14 cases(58.3% ) underwent resection of hepatic metastases, while synchronous hepatic metastasis occurred in 90 cases(9.6% ) and 18 cases(20% ) underwent resection of hepatic metastases. The 1- 3- 5- year survival rates of hepatic resection for metachronous hepatic metastases were 73% 37% 25% respectively; while for synchronous hepatic metastases 68% 24% and 17% respectively. There were no significant differences between the two groups (P> 0.05). Synchronous and metachronous hepatic metastases from gastric cancer should be treated by surgical resection to confirm a better prognosis.

Concurrent vs. staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases.

Resection of hepatic metastases is the preferred treatment for selected patients after resection of primary colorectal carcinoma, but timing is controversial. This study was designed to compare outcomes of patients receiving concurrent resection of hepatic metastases and the primary colorectal tumor with those of patients receiving staged resection (within 6 months). We retrospectively analyzed medical records (1986-1999) of 96 consecutive patients with synchronously recognized primary carcinoma and hepatic metastases who underwent concurrent (64 patients) or staged (32 patients) colonic and hepatic resections performed at our institution. Concurrent and staged groups were similar in demographics, tumor grade, stage, preoperative comorbidity (cardiac and respiratory), characteristics of hepatic metastases, and single vs. multiple lesions. No significant differences were observed between groups (concurrent vs. staged) in type of colon resection (P = 0.45) or hepatic resection (P = 0.09), overall operative duration (mean, 430 vs. 427 minutes; P = 0.39), blood loss (mean, 890 vs. 889 ml; P = 0.87), volume of blood products transfused (mean, 326 vs. 185 ml; P = 0.08), perioperative morbidity (53 vs. 41 percent; P = 0.25), disease-free survival from date of hepatectomy (median, 13 vs. 13 months; P = 0.53), or overall survival from date of hepatectomy (median, 27 vs. 34 months; P = 0.52). There was no operative mortality. Overall duration of hospitalization was significantly shorter for concurrent than for staged resection (mean, 11 vs. 22 days; P < or = 0.001). Concurrent colectomy and hepatectomy is safe and more efficient than staged resection and should be the procedure of choice for selected patients in medical centers with appropriate capacity and experience.

The role of tissue factor expression in the invasive and metastatic ability of colorectal carcinoma

To investigate the role of tissue factor (TF) expression in the invasive and metastatic ability of colorectal carcinoma and explore the influence of TF on the invasive ability of HT-29 cells. TF expression of specimens from 85 colorectal carcinomas and 6 colorectal adenomas was observed by immunohistochemistry. The role of TF expression in prognosis and tumor invasion and metastasis was analyzed. The plasmids pcDNA3.1/Zeo bearing either sense or antisense-TFcDNA were transfected into HT-29 cells by the way of Lipofectamine 2000. TF proteins in transfected and untransfected HT-29cells were detected by Western blot. In vitro Matrigel invasion assays were performed to show the invasive ability of those cells. TF expression was positive in 40 (47.1%) of 85 colorectal carcinoma specimens, but negative in normal mucosa and adenoma specimens. TF expression showed significant correlation with tumor invasive depth (r = 0.895, P < 0.01). TF expression showed significant correlation with synchronous and metachronous hepatic metastasis (r = 0.974, P < 0.01 and r = 0.963, P < 0.01 respectively). TF expression was a significant risk factor for hepatic metastasis (P < 0.01) and prognosis (P < 0.01). TF expression in HT-29 cells with sense/antisense-TFcDNA transfection was more/less than that of the cells without transfection. The invasive ability of HT-29 cells with sense-TFcDNA transfection was increased in vitro compared with the untransfected cells, but HT-29 cells with antisense-TFcDNA transfection got the contrary change. TF may take part in the invasive and metastatic process of primary colorectal carcinoma, and TF expression may be an indicator of hepatic metastasis and prognosis for colorectal carcinoma patients. TF expression may increase the invasive ability of HT-29 cell in vitro.

Management of a solid pseudopapillary tumor of the pancreas with liver metastases

Solid pseudopapillary tumor, otherwise known as solid and cystic tumor or Frantz tumor, is an unusual form of pancreatic carcinoma. Its natural history differs from the more common pancreatic adenocarcinoma in that it has a female predilection, is more indolent, and carries a better prognosis. Metastatic disease can occur, usually involving the liver, and its management is not well defined. A young woman was found to have a tumor situated in the pancreatic tail with seven synchronous hepatic metastases. Segments II and III were free of metastatic disease. A needle biopsy of the pancreatic lesion was non-diagnostic but suggested that the lesion was unlikely to be a typical adenocarcinoma. Initial treatment consisted of a distal pancreatectomy, which confirmed the diagnosis of a solid pseudopapillary tumor. Given the indolent nature of this pathologic entity as well as the patient's youth, an aggressive approach to treatment of the hepatic metastases was recommended. Because the liver was fatty, the right portal vein was embolized to produce hypertrophy of the left hemiliver. Six weeks later an extended right hepatectomy cleared the hepatic disease. The patient had an uncomplicated recovery, and she remains disease-free at 22 months. Solid pseudopapillary tumor of the pancreas is a rare malignancy. Survival following primary resection approaches 95% at 5 years. Metastatic disease, although rare, usually involves the liver and/or peritoneum. Given the paucity of reported cases, the management of metastatic disease is, to date, poorly defined. This case demonstrates a favorable short-term outcome with aggressive surgical treatment of both the primary and metastatic tumor.

Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis.

The optimal surgical strategy for the treatment of synchronous resectable colorectal liver metastasis has not been defined. The aims of this study were to review our experience with synchronous colorectal metastasis and to define the safety of simultaneous versus staged resection of the colon and liver. From September 1984 through November 2001, 240 patients were treated surgically for primary adenocarcinoma of the large bowel and synchronous hepatic metastasis. Clinicopathologic, operative, and perioperative data were reviewed to evaluate selection criteria, operative methods, and perioperative outcomes. One hundred thirty-four patients underwent simultaneous resection of a colorectal primary and hepatic metastasis in a single operation (Group I), and 106 patients underwent staged operations (Group II). Simultaneous resections tend to be performed for right colon primaries (p < 0.001), smaller (p < 0.01) and fewer (p < 0.001) liver metastases, and less extensive liver resection (p < 0.001). Complications were less common in the simultaneous resection group, with 65 patients (49%) sustaining 142 complications, compared with 71 patients (67%) sustaining 197 complications for both hospitalizations in the staged resection group (p < 0.003). Patients having simultaneous resection required fewer days in the hospital (median 10 days versus 18 days, p = 0.001). Perioperative mortality was similar (simultaneous, n = 3; staged, n = 3). Simultaneous colon and liver resection is safe and efficient in the treatment of patients with colorectal cancer and synchronous liver metastasis. By avoiding a second laparotomy, the overall complication rate is reduced, with no change in operative mortality. Given its reduced morbidity, shorter treatment time, and similar cancer outcomes, simultaneous resection should be considered a safe option in patients with resectable synchronous colorectal metastasis.

本邦における大腸癌同時性肝転移に対する治療の現況 第２報 全国アンケート追跡調査結果

大腸癌の同時性肝転移に対する本邦における治療の現況を明らかにするため,1997年の初回全国アンケート調査を引き継いで登録症例の追跡調査を行った.初回集積症例3,212例のなかで最終的に1,843症例が集積された.そのうちの解析適合症例446例を解析した.Hステージ別,転移個数別,転移腫瘍径別に治療方法別の有効性を検討したが,全てのステージで外科的切除が最も有効であった.特にH1症例,転移数3個以下,転移腫瘍径2.0cm以下の症例では,外科的切除を第一選択とすべきことが示唆された.またH2以上,転移個数4個以上,腫瘍径2.1cm以上の症例に関しては動注療法も有効であった.全身化学療法もH3や転移数5個以上のステージの進行した症例では有効性が認められた.

Concurrent resections of pancreatic islet cell cancers with synchronous hepatic metastases: Outcomes of an aggressive approach

Background. Pancreatic islet cell cancers are often characterized by the presence of endocrinopathies, an indolent clinical course, and a propensity for hepatic metastases. Hepatic metastases are associated with a negative impact on survival. The role of concurrent resections of pancreatic islet cell cancers and the hepatic metastases has not been defined. Methods. The records of all consecutive patients undergoing concurrent resections of pancreatic islet cell cancers and their hepatic metastases between 1980 and 1998 were reviewed. Outcomes regarding overall progression-free and symptom-free survival and perioperative morbidity and mortality were assessed. Results. All 23 patients underwent distal pancreatectomy and splenectomy. Six major (≥ 3 segments) and 17 minor (c3 segments) partial hepatectomies were performed. Complete gross resection of cancer (R0/R1) were performed in 9 patients and debulking resections (R2) (<10% residual tumor volume) in 14 patients. There were no perioperative deaths. Major complications occurred in 4 patients (18%). Overall, progression-free, and symptom-free survival was 71% (median: 76 months), 5% (median: 21 months), and 24% (median: 26 months), respectively, at 5 years. Conclusions. These data support aggressive concurrent resection of the pancreatic islet cell cancers and synchronic hepatic metastases when technically feasible. Because disease progression is frequent and the major cause of death, investigations of adjuvant and adjunctive therapies are warranted. (Surgery 2002;132:976-83.)

Initial presentation with stage IV colorectal cancer: how aggressive should we be?

The appropriate surgical treatment of patients with colorectal cancer who are found on initial presentation to have stage IV disease is controversial. With presumed limited life expectancy, the role of primary colon or rectal resection has been questioned, as has the utility of synchronous hepatic resection. A retrospective chart review. The University of Chicago Hospitals, Chicago, Ill, a tertiary-care referral center. One hundred twenty patients were identified through The University of Chicago Hospitals Tumor Registry whose initial presentation showed stage IV colorectal cancer and who underwent laparotomy. The primary end points of the study were perioperative morbidity and mortality and overall survival. Median survival and 5-year survival were 14.4 months and 10%, respectively. Survival was greater for patients younger than 65 years than for those who were aged 65 years or older (18.3 vs 9.8 months; P = .007). Carcinomatosis was associated with significantly decreased survival when compared with less extensive stage IV disease (6.7 vs 18.1 months; P<.001). Patients who underwent any form of resection of hepatic metastases achieved a survival advantage over those with unresectable liver lesions (median survival, 29.6 vs 10.2 months; P<.001). Overall, 27 patients (22.5%) developed postoperative complications. Seven patients (5.8%) died during the postoperative period. Age of 65 years or older, carcinomatosis, and extensive (bilobar) liver involvement are associated with decreased survival and increased postoperative morbidity and mortality and may negate any potential benefit patients derive from resection of the primary lesion. A substantial number of patients with synchronous hepatic metastases have protracted survival that justifies resection of the primary colorectal tumor at initial presentation. Despite the presence of stage IV disease, resection of the primary tumor and, when feasible, liver metastases is indicated.

Tissue factor expression in human colorectal carcinoma: correlation with hepatic metastasis and impact on prognosis.

It has been suggested that tissue factor (TF) plays an important role in tumor metastasis. Its expression in sarcoma cells was reported to up-regulate the vascular endothelial growth factor (VEGF) gene and thereby enhance tumor angiogenesis, which is essential to tumor metastasis. Although many malignant tumors have been reported to express this protein constitutively, recent clinical studies have focused mainly on the correlations among TF expression, tumor progression, and histologic grade. Therefore, to address the role of TF and the underlying mechanism of hematogenous metastasis of colorectal carcinoma, the authors analyzed the correlations among TF expression, hepatic metastasis, and VEGF gene expression in surgical specimens. Furthermore, they analyzed the prognostic significance of TF expression with respect to overall patient survival. Expression of TF and VEGF genes in 67 advanced colorectal carcinoma specimens was studied by immunohistochemistry and Northern blot analysis, respectively. The correlations among TF expression, hepatic metastasis, and other factors were analyzed with univariate and multivariate statistics. Survival rates were calculated using the Kaplan-Meier method. Univariate and multivariate analyses showed TF expression to be a significant (P = 0.0001) and independent risk factor for hepatic metastasis, whereas a weak but insignificant correlation was observed between TF and VEGF gene expression. The outcomes in the TF positive group were significantly worse in all cases (P = 0.0001) and in the cases without synchronous hepatic metastasis (P = 0.0156). Although the precise mechanisms are unknown, TF expression is a suitable indicator of both hepatic metastasis and prognosis for colorectal carcinoma patients.

Bombesin family receptor and ligand gene expression in human colorectal cancer and normal mucosa.

Bombesin-like peptides and their receptors are widely distributed throughout the gut and are potential mitogens for a number of gastrointestinal (GI) cancers. We have analysed the expression of bombesin-like peptides and their receptor subtypes in normal and neoplastic colorectal tissue. Expression was analysed by reverse transcription polymerase chain reaction (RT-PCR) using receptor and ligand subtype-specific primers and then expression localized by in situ hybridization (ISH) with riboprobes synthesized by in vitro transcription of cloned PCR products. Colorectal cancer tissue and matched normal mucosa from 23 patients were studied. Two of these patients had synchronous adenomatous polyps and two had synchronous hepatic metastases which were also studied. An additional two patients with adenomatous polyps were studied along with matched normal mucosa. Gastrin releasing peptide (GRP) receptor and ligand expression was present in all samples but with overall greater expression in the tumour samples. Neuromedin B (NMB) receptor expression was not detectable. NMB ligand was detected in all but one mucosal sample with overall overexpression in the tumour samples. Bombesin receptor subtype 3 (BRS-3) receptor expression was not detectable. These data support the possibility that GRP may be an autocrine growth factor in colorectal cancer. © 2000 Cancer Research Campaign

本邦における大腸癌同時性肝転移に対する治療の現況 全国アンケート調査結果

大腸癌の同時性肝転移に対する本邦での治療の現況を明らかにするため,大腸癌研究会に所属する全国の主要施設にアンケート調査を行った.転移程度別にいかなる治療方法が有効であるのかを明確にすることを目的とした.H1,H2,H3のすべてのステージで外科的切除が最も有効であった。H2,H3症例では動注化学療法も有効であった.全身化学療法,TAE, PEIT, MCTのそれぞれ単独での有効性や切除後の補助療法としての動注療法の有効性は立証できなかった.H1症例では転移個数と腫瘍径が,H3では腫瘍径がハザードに影響を与えていた.このアンケート調査結果を踏まえ,将来的にプロジェクト研究としてさらなる症例の蓄積と詳細な検討を行い,肝転移の総括的な研究が前進することが重要なことであると思われる.

Alpha-fetoprotein-producing gastric cancer.

We measured the sero-positivity rate of serum alpha-fetoprotein (alphaFP) of gastric cancer patients by ELISA assay; forty-two curatively resected patients, 14 palliatively resected patients, 8 who received explo-laparotomy or bypass surgery and 18 patients with systemic metastasis. The sero-positive rate was 9.8% (8/82) and the positivity increased with cancer progression. Sex, age and pathological type were similar between alphaFP-positive and -negative patients. The overall synchronous hepatic metastasis rates in alphaFP-positive and alphaFP-negative groups were 37.5% (3/8) and 12.2% (9/74), respectively (p=0.08). The predictability of synchronous liver metastasis in eight alphaFP-positive patients were as follows: 37. 5% of total patients (3/8), 50.0% (3/6) of unresectable patients, and 60.0% (3/5) of patients with systemic metastasis. In three alphaFP-positive patient with liver metastasis, all the hepatic lesions were intrahepatic and multiple, while in alphaFP-negative patients, 67% (6/9) of the hepatic lesions was single intrahepatic lesion or surface nodule. The predictability of both synchronous and metachronous liver metastasis in alphaFP-positive gastric cancer patients was 75%. These findings suggested that, in advanced stomach cancer patients, especially in stage IV, alphaFP can be used in predicting liver metastasis during follow-up.

Differences in Tumor Growth Measured by Carcinoembryonic Antigen Doubling Time between Synchronous and Metachronous Hepatic Colorectal Metastases

The operative results and carcinoembryonic antigen (CEA) doubling times of patients with synchronous hepatic metastasis (group A) and metachronous hepatic metastasis (group B) from colorectal carcinom

Histologic features and clinical significance of venous invasion in colorectal carcinoma with hepatic metastasis.

In colorectal carcinoma, venous invasion has been related to patient survival. Liver metastasis develops more frequently when venous invasion is present. However, the histologic features and clinical significance of venous invasion are not well understood. A histologic study of venous invasion in colorectal carcinoma was performed on 19 patients with synchronous hepatic metastasis (Group A), 16 patients with metacaronous hepatic metastasis (Group B), and 26 patients with Dukes Stage C tumors who survived for 5 years without recurrence (Group C). The histologic features of venous invasion were classified into three types: tumor cells that were distant from the vein walls were categorized as floating type, those filling the lumen of a vein as filling type, and those surrounded by a vein obliterated with inflammatory reaction as occlusive type. Venous invasion was present in 89.5% of Group A patients and 75% of Group B patients, which was significantly higher than the 15.4% observed in Group C patients (P < 0.001). A slight to extensive degree of venous invasion was found in Groups A and B, but no extensive venous invasion was found in Group C. All patients in Groups A and B (except one patient) had floating, filling, or a combination of floating and filling types of venous invasion, whereas all patients in Group C had the occlusive type of venous invasion. A majority of the patients in all three groups showed invasion of extramural veins. There is a close relationship between venous invasion and the development of liver metastasis in patients with colorectal carcinoma. Patients with no sign of metastasis had a lower incidence and lower extent of venous invasion, and inflammatory damage to the vein walls around the intravenous tumor appeared to reduce the likelihood of distant metastasis.

Hepatic resection for metastases from colorectal carcinoma--a survival analysis.

Between 1 January 1984 and 31 December 1992, 66 patients with hepatic metastases from colorectal carcinomas underwent liver resection. 40 of these patients had synchronous hepatic metastases, and liver resection was carried out simultaneously with radical resection of the primary tumour; in 26 cases metachronous metastases in the liver were surgically removed. 25 patients had an anatomical resection and the remainder underwent atypical resections. The postoperative mortality rate was 4.5% and the major complication rate was 19.7%. Univariate and subsequently multivariate analyses were used to predict the influence of various clinical, histopathological and surgical variables. The observed 5-year survival rate was 29.6% and the 5-year disease-free survival rate 13.9%. Furthermore, the observed median survival time was 24.7 months and the mean disease-free survival time was 16.7 months. Multivariate analysis showed that stage of primary (pTN) (P = 0.043), tumour grading (P = 0.013) and site of primary (P = 0.007) were factors which independently influenced 5-year disease-free survival whereas stage of primary (pTN) (P = 0.008), tumour grading (P = 0.004) and type of resection (P = 0.035) were identified as having independent influence on 5-year observed survival. We consider liver resection to be an effective form of treatment for patients with resectable liver metastases from colorectal carcinoma, although the overall chances for cure are generally not very promising. It appears that the biological behaviour of the primary tumour, in terms of tumour stage and grading, has the greatest influence on survival.