Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history

Although aggressive surgical treatment of metastatic disease is not usual, it has been reported that treatment of liver metastasis from colorectal cancer by liver resection (surgical removal of a portion of the liver) has a low mortality and a five-year survival rate ranging from 16 to 52 percent. To evaluate the usefulness of liver resection, a prospective study was undertaken of 1,221 patients treated over a 28-year period who had liver metastasis from colorectal cancer. There were 967 patients who underwent surgery for confirmation and staging of the progress of disease. Group 1, consisting of 921 patients (902 had non-resectable disease, and 19 could not be clearly classified), had 21 patients surviving at three years, and none at five years. The second group (62 patients) had resectable metastatic disease, but because a different treatment method had been chosen, the liver was not resected. In this group, median survival was 14.2 months (compared with 6.9 months for group 1); there were no survivors at five years. Group 3, consisting of 226 patients, had liver resection performed. Of this group, 43 had residual disease after resection, and survival was similar to that of group 2. Ten of the remaining 183 patients in group 3 who had potentially curative resection died after surgery. The remaining 173 patients in group 3 had survivals of 40 percent at five years and 27 percent at 10 years (25 patients alive at five years, and seven at 10 years.) There are 64 patients who have remained disease-free for up to 24 years. It is concluded that radical excision of liver metastasis in colorectal cancer can provide effective palliation (reduction of pain and discomfort), and in a small proportion of patients, a chance of cure. (Consumer Summary produced by Reliance Medical Information, Inc.)