Abstract
Background. Hepatic resection is an accepted therapeutic modality for isolated colorectal metastases
(CRM) and primary hepatobiliary cancers (PC). Controversy continues regarding the
safety, efficacy, and appropriateness of resection for noncolorectal metastases (NCM).
Methods. A retrospective review of 167 resections in 160 patients was performed to evaluate
the impact of demographics and perioperative data on survival and recurrence. Statistical
analyses were performed by Student t test, analysis of variance, and Kaplan-Meier
survival estimates. Results. Resections were performed for CRM, 110 of 167 (66%), NCM, 31 of 167 (19%), and PC,
26 of 167 (15%). The interval from primary to metastases was significantly longer
in the NCM group than the CRM group (34.7 ± 45.1 vs 18.7 ± 23.7 months; P <.01). Mean number of lesions was not different between groups; however, NCM were
larger than CRM (5.9 ± 4.5 vs 4.5 ± 2.9 cm; P <.05). Operative complications were significantly greater for PC (54%) versus CRM
and NCM (21% and 19%, respectively; P <.01), although length of stay was similar between groups. Perioperative mortality
was 2%. Actuarial survival at 1 year, 3 years, and 5 years was CRM 91%, 54%, and 40%,
PC 75%, 60%, and 38%, and NCM 68%, 36%, and not available, respectively (CRM vs NCM;
P <.01 at 3 years). Conclusions. Hepatic resection for primary and secondary malignancy can be performed with minimal
morbidity and mortality. Resection of NCM is associated with a lower overall survival
compared with CRM and PC. The disease-free interval from resection of the primary
to metastasectomy is prolonged and hepatic recurrence infrequent after resection in
the NCM group. These results suggest that tumor biology is a critical determinant
of outcome after hepatic resection of primary and secondary hepatic tumors. (Surgery
2000;128:686-93.)
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Article info
Footnotes
*Reprint requests: Mitchell C. Posner, MD, Department of Surgery, University of Chicago Hospitals, Pritzker School of Medicine, 8541 S Maryland Ave, Chicago, IL 60637.
**Surgery 2000;128:686-93
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
