Hepatic Resection for Metastatic Colon and Rectal Cancer

Abstract

Hepatic resection for metastatic colorectal cancer has been reported in over 700 patients. However, approximately 5000 patients each year are candidates for surgical excision. Since 1972, 25 patients have undergone hepatic resection for colorectal metastases in New York University [USA]. Potentially curable synchronous lesions were detected by preoperative liver chemistries and operative palpation. Patients were screened for metachronous lesions by serial liver chemistries and carcinoembryonic antigen (CEA) determinations; when clinical findings or laboratory findings were either positive or equivocal, then scanning techniques were used. Most patients had solitary lesions (20). Thirteen of 25 lesions were synchronous; 12 were metachronous. Anatomic lobectomy was performed in 13 patients (6 extended resections); and wedge resection was performed in 12. The operative mortality rate was 4%; the 2 yr survival rate, 65%; the 5 yr survival rate, 25%. Hypertonic dextrose solutions were administered during and after operation. Postoperative albumin requirements ranged from 200-300 g/day. Coagulation factors II, V, VII and fibrinogen decreased after surgery to 30-50% of their preoperative levels. Subsequent elevation of these factors correlated with increased bile production and improvement in liver chemistries 10-14 days after operation. At present, hepatic resection for colorectal metastases provides the only potential method of salvage, offering a 20-25% long-term survival rate.