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Results of R0 Resection for Colorectal Liver Metastases Associated With Extrahepatic Disease

From the Departments of Surgical Oncology (DE, LS, MP, J-FO, PL), Medical Oncology (VB, MD), and Biostatistics and Epidemiology (J-PP), Gustave Roussy Institute, Villejuif, France.

Correspondence: Address correspondence and reprint requests to: Dominique Elias, MD, PhD, Department of Surgery, Division of Surgical Oncology, Gustave Roussy Institute, Rue Camille Desmoulins, 94805, Villejuif CEDEX, France; Fax: 33-1-42-11-52-56; E-mail: elias{at}igr.fr

Background: Extrahepatic malignant disease has always been considered an absolute contraindication to hepatectomy for colorectal liver metastases. This study reports the long-term outcome and prognostic factors of patients undergoing extrahepatic disease resection simultaneously with hepatectomy for liver metastases.

Methods: From January 1987 to January 2001, 75 patients underwent a complete R0 resection of extrahepatic disease simultaneously with hepatectomy for colorectal liver metastases. They were inscribed in a registry and then prospectively followed up. They represented 25% of the 294 patients who underwent an R0 hepatectomy for colorectal liver metastases during the same period.

Results: The mortality rate was 2.7%, and morbidity was 25%. After a median follow-up of 4.9 years (range, 1.7–13.4 years), the overall 3- and 5-year survival rates were 45% and 28%, respectively. By using a Cox model, there was a significant difference in survival between patients with single versus multiple sites of extrahepatic disease. Also, the presence of more than five liver metastases was a significant parameter.

Conclusions: Extrahepatic disease in colorectal cancer patients with liver metastases should no longer be considered as a contraindication to hepatectomy. However, this intended R0 resection cannot be performed in 50% of laparotomized patients, and negative prognostic factors for surgery include the presence of multiple extrahepatic disease sites or more than five liver metastases.

Key Words: Liver metastases • Colorectal • Extrahepatic disease • Surgery

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