Liver Resection for Multiple Colorectal Liver Metastases with Surgery Up-front Approach: Bi-institutional Analysis of 736 Consecutive Cases
World Journal of Surgery,

Saiura A et al. – In patients with multiple liver metastases, the number of liver metastases has less impact on the prognosis than other prognostic factors. Complete resection with repeat metastasectomy offers a chance of cure even in patients with numerous colorectal liver metastases (i.e., those with eight or more nodules).

Methods
  • Data collected prospectively over a 16–year period for 736 patients who underwent hepatic resection at two different centers were reviewed.
  • Patients were divided into three groups depending on the number of tumors as follows: group A, between one and three tumors (n = 493); group B, between four and seven tumors (n = 141); and group C, eight or more tumors (n = 102).

Results
  • The 5–year overall and recurrence–free survival rates were 51 and 21 %, respectively, for the entire patient cohort, 56 and 29 % in group A, 41 and 12 % in group B, and 33 and 1.7 % in group C.
  • Multivariate analysis showed that decreased survival was associated with positive lymph node metastasis of the primary tumor, the presence of extrahepatic tumors, a maximum liver tumor size >5 cm, and tumor exposure during liver resection.

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