2005 Abstracts: Do Aggressive Surgeries Improve the Prognosis of the Colorectal Liver Metastases?
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Do Aggressive Surgeries Improve the Prognosis of the Colorectal Liver Metastases?
zenichi morise, Dept of Surgery, fujita health university school of medicine, toyoake, aichi, Japan; Atsushi Sugioka, Fujita Health University School of Medicine, Toyoake, aichi, Japan; Junko Fujita, Sojun Hoshimoto, Takazumi Kato, Akitake Hasumi, Department of Surgery, Fujita Health University School of Medicine, toyoake, aichi, Japan; Takashi Suda, Hiromichi Negi, Yoshinobu Hattori, Fujita Health University School of Medicine, toyoake, aichi, Japan; Kotaro Maeda, Department of Surgery, Fujita Health University School of Medicine, toyoake, aichi, Japan; Takahiko Funabiki, Fujita Health Univ Schl of Medicine, toyoake, aichi, Japan
Hepatic resection for the colorectal metastases was performed for 177 patients, 207 times (87 patients with multiple metastases, 27 and 24 with repeat hepatectomies and the pulmonary resection for the metastases, respectively) until May 2004 in our hospital. We herein evaluate the impact of the aggressive surgery (hepatectomies of multiple lesions and multiple times, and the resection of lung metastases).
Overall survival rates of the cases after the first hepatectomy are 39.1%, 27.5% for 5, 10 years. There are 117 cases with uni-lobular hepatic metastases (H1, including 26 cases with multiple metastases: H1-multi), 38 cases with 4 or less bi-lobular hepatic metastases (H2) and 22 cases with more than 4 bi-lobular metastases (H3). The survival rates of H1 cases are 48.7%, 41.4% for 5, 10 years, and significantly higher than those of H2 and H3 cases. However, the differences between the survival rates from H1-multi, H2 and H3 are not significant, even though that of H3 cases is lower than other two groups. Although 4 cases of H3 survived more than 5 years with repeat surgeries and chemotherapies, 2 of them died of recurrence past after 5 years. The 5-year-survival rates after the second hepatectomy and the resection of the lung are 32.7 and 39.6 %, respectively. Interestingly, the 5-year-survival rates from the first metastasectomy (of the liver or the lung), 43.7 and 57.6 %, for the second hepatectomy and the resection of the lung groups, respectively, are higher than that of overall cases from the first hepatectomy. Among 121 cases past more than 5 years after the hepatectomies, 33 cases actually survived more than five years. They are including 10 cases with multiple metastases from total of 57 cases and 5 out of those 10 cases underwent multiple surgeries. There are 13 patients who underwent multiple repeat (3 or more times) resections of the liver and/or lung in our series. The 5-year-survival rate of the patients from the first metastasectomy is 57.1 %. Although the survival rate of the patients with multiple liver metastases from colorectal carcinoma is significantly lower than that of the patients with solitary metastasis, the fact that quite a few patients with multiple metastases actually survived more than 5 years encourages the application of the procedure. Repeat surgeries after the first hepatectomy contribute to the improving prognosis.
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