Resection of synchronous liver metastases from colorectal cancer

Background: The prognosis for patients with liver metastasesfrom colorectal cancer is still poor. Thus, patient selectionfor hepatic resection is essential to improve the poor resultsof the procedure. Some reports have shown that the prognosisfor patients with synchronous liver metastases is worse thanthat for those with metachronous liver metastases. Therefore,determination of the factors that influence outcome after resectionof synchronous liver metastases is more important than withmetachronous liver metastasis. Method: We studied patients who had been followed for more than5 years after undergoing resection of synchronous liver metastasesfrom colorectal cancer. Results: Among the 12 prognostic factors studied (age, gender,adjuvant chemotherapy, tumor site, CEA level, tumor differentiation,tumor size, regional lymph node metastatic status, distributionof liver metastases, number of liver metastases, tumor sizeand pathological margin), regional lymph node metastatic statusand pathological margin were significant prognostic factorsby univariate analysis (p = 0.0002 and 0.005, respectively).Regional lymph node metastatic status was a significant prognosticfactor by multivariate analysis (p = 0.031). The survival curveof patients with six or more regional lymph node metastaseswas similar to that of patients with non-resectable liver metastasis. Conclusion: The resection of synchronous liver metastases inpatients with six or more regional lymph node metastases isrelatively contraindicated. For these patients, other treatmentmodalities should be considered. ⁺ For reprints and all correspondence: Shin Fujita, Departmentof Surgery, National Cancer Center Hospital, 1–1 Tsukiji5-chome, Chuo-ku, Tokyo 104-0045, Japan. E-mail: sfujita@gan2.ncc.go.jp