Major Hepatic Resections for Metastatic Colorectal Cancer

In 1973, our study of patients with resectable hepatic metastases from colorectal cancer compared survival of 60 patients who had metastases removed with survival of 60 patients with similar lesions that had been biopsied only. We concluded that excision of small, apparently solitary metastatic lesions could be justified on the basis of the low operative risk and prolonged survival. However, the risks and benefits of resection of larger metastatic lesions could not be determined by that earlier study, because only seven of those patients had lesions so large as to require major hepatic resection. Therefore, to evaluate size as a determinant of prognosis after resection, we added to those 7 patients 27 others who were managed since 1973 by major hepatic resection of larger metastases. There were two hospital deaths. Of the 32 surviving patients, 82% lived one year or more, 77% 18 months or more, 58% two years or more, and 41% three years or more postoperatively. Three patients are living 10--22 years after resection. We conclude from a critical analysis of the duration and quality of life of surviving patients that at least 20% and perhaps 30% of these patients were benefited by major hepatic resection of their large hepatic metastasis.