Multicentre study of liver metastases from colorectal cancer in pathological livers

Objectives

Resection of colorectal cancer (CRC) liver metastases (LM) in pathological liver (PL) patients (with cirrhosis or hepatopathy) is extremely rare. The aim of this study was to perform a multicentre, retrospective analysis of epidemiology, surgical techniques and outcomes in patients with PL who underwent hepatic resection for CRC-LM.

Methods

A retrospective, multicentre questionnaire was distributed to 15 hepatopancreatobiliary surgical units.

Results

Only six of 15 (40%) HPB units reported any experience in the surgical resection of CRC-LM in patients with PL. Of the 20 patients identified, 10 had underlying cirrhosis and 10 had chronic hepatopathy. Their median age was 66 years (range: 49–81 years). Thirteen patients were male. Liver dysfunction was known preoperatively in 18 patients. All patients had Child–Pugh class A disease. Six patients had synchronous disease. There were a total of 38 lesions among the 20 patients, distributed at a median of one lesion per patient (range: 1–4 lesions). The median size of the lesions was 3.0 cm (range: 1.5–9.0 cm). Preoperative median carcinoembryonic antigen (CEA) was 32.3 ng/ml (range: 1–184 ng/ml). The surgical procedures performed included: sub-segmentectomy (n = 12); left lateral sectionectomy (n = 6); segmentectomy (n = 4); radiofrequency ablation (n = 3), and exploratory laparotomy (n = 4). Morbidity occurred in four patients (Clavien grades I [n = 1], II [n = 2] and IVa [n = 1]). Mortality was nil. An R0 resection margin was achieved in 15 of 16 patients. Twelve patients did not receive chemotherapy. In resected patients, 10 presented with relapse. The median disease-free and overall survival periods were 12.2 and 22.3 months, respectively.

Conclusions

When feasible, liver resection is the best option for CRC-LM in PL patients.