Resection of hepatic metastases in colorectal cancer

Only one possibility: Surgical resection is the only treatment which gives any hope of prolonged survival in patients with hepatic metastasis of colorectal cancer. Well-defined indications: Hepatic metastases occur in one out of two cases of colorectal cancer. Repeated systematic explorations (ultrasound, carcinoembryonic antigen assay) before and after surgery for the primary tumor are required for as long as major surgery for extension would be possible. Hepatic resection metastatic colorectal cancer is indicated in cases where total resection is possible under conditions compatible with satisfactory liver function and the patient general status. Results: In a group of candidates for hepatic resection, 5-year survival after surgery is 25 to 30%. The main prognosis factors are histological stage of the primary tumor, interval to development of hepatic metastasis, extrahepatic dissemination, number and size of the metastases, preoperative CEA level, absence of nodal involvement in the hepatic pedicle, and the anatomy of the liver resection. Repeat resection is possible for recurrence after an initial hepatic resection with results similar to the first operation. Few complications: Mortality for hepatic resection is less than 4% and morbidity, including hemorrhagic, biliary, infectious and pulmonary complications, reaches 20 to 30%. (C) 1998, Masson, Paris.