Abstracts
2000 Digestive Disease Week

# 2277 Resection of Hepatic Metastases in Patients Traditionally NOT Considered Resection Candidiates.
Joseph F. Buell, Daniel M. Labow, Atsushi Yoshida, Ralph Layman, David C. Cronin, J. Michael Millis, Mitchell C. Posner, Chicago, IL

Hepatic resection for metastatic disease is considered appropriate in colorectal cancer (CRC) patients with minimal tumor burden (£3 metastases)isolated to the liver. Metastasectomy in the presence of advanced age, bilobar disease or non-colorectal metastases is controversial. We examined the efficacy of hepatic resection in this cohort. Methods: Sevety-seven non-traditional resection candidates (NTR) were identified and compared to sixty-three traditional resection (TR)candidates composed of patients with unilobar colorectal cancer whose age was less than 70 yrs. Statistical comparisions of demographics and survival were performed by student’s t-test, actuarial survivals, and log-rank analysis. Results: The NTR group was composed of 21 CRC patients = 70 yrs of age, 25 patients with bilobar CRC and 31 with non-CRC metastases. Patients with bilobar disease had a significantly decreased disease-free interval from primary resection to metastatic disease when compared to the TR group (9.6±9.3 vs. 20.9±28.1 mos.;p<0.006). Both the number and size of metastatic lesions were significantly greater in the NTR group compared to the TR group (2.2±1.5 vs. 1.6±1.2 lesions; p<0.02 and 5.7±3.6 vs. 3.8±2.8 cm;p<0.002), respectively. Resection margins were not different between the groups. Length of hospital stay (7.7±4.5 vs. 7.5±1.8 days),90-day mortality (2/77 vs. 0/63)and morbidity rates (12% vs.10%)were similar. Disease- free survival at 1, 3 and 5 yrs was significantly different between the NTR and TR group: 81±4, 41±7,and 23±8% vs. 93±3, 60±7,and 49±8%; p<0.008. Patients > 70 years of age with CRC demonstrated an equivalent 5-year survival compared to the TR group (42±14% vs. 49±8%; p=NS). Patients with bilobar CRC had a decreased 5-yr survival when compared to the TR group(25±11%; p=0.056). The non-CRC group had a significantly diminished 3-yr. survival (36±13%; p<0.002) when compared to TR. Conclusions: Hepatic resection in NTR patients can be performed with minimal morbidity and mortality. Despite decreased survival in the NTR cohorts particularly those with bilobar disease or non-CRC metastases, when the NTR group is compared to TR patients, survival approximates those historically reported for resection of hepatic CRC metastases. These data suggest liberalizing the indications for resection of hepatic metastases may have a substantial impact.