Hepatic Resection for Metastases of the Colon and Rectum

Hepatic resection is the treatment of choice for a solitary metastatic deposit from a primary carcinoma of the large intestine in the absence of extrahepatic disease. This study was done to evaluate hepatic resection in the treatment of multiple hepatic metastases from carcinoma of the colon and rectum. Sixty-two patients underwent hepatic resection with an over-all operative mortality of 10 per cent, but a recent (1968-1981) mortality of 2 per cent. Three, five and ten year survival rates were 50, 34 and 21 per cent, respectively. No significant differences in survival patterns were noted comparing site (colon versus rectum), time interval from diagnosis of the primary to diagnosis of metastases (synchronous versus metachronous), sex (male versus female), size of the metastatic lesion (less than 5 centimeters versus greater than or equal to 5 centimeters) or number of metastatic lesions (single versus multiple). The pathologic stage of the primary carcinoma of the large intestine significantly (p less than 0.05) influenced survival patterns after hepatic resection with Dukes' B primary tumor having a median survival time of 123 months versus 27 months for patients with Dukes' C primary tumor. Sixty-seven per cent of those with a recurrence did so within the liver. Adjuvant chemotherapy had no demonstrable effect on survival patterns. Further improvement in survival statistics will require more sensitive staging procedures and effective adjuvant therapy, particularly for patients with Dukes' C primary carcinoma of the large intestine.