Original Article
Copyright ©2009 Baishideng. All rights reserved.
World J Hepatol. Oct 31, 2009; 1(1): 79-89
Published online Oct 31, 2009. doi: 10.4254/wjh.v1.i1.79
Aggressive liver resection including major-vessel resection for colorectal liver metastases
Kuniya Tanaka, Ryusei Matsuyama, Kazuhisa Takeda, Kenichi Matsuo, Yasuhiko Nagano, Itaru Endo
Kuniya Tanaka, Ryusei Matsuyama, Kazuhisa Takeda, Kenichi Matsuo, Yasuhiko Nagano, Itaru Endo, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
Author contributions: Tanaka K designed the research; Tanaka K, Nagano Y, and Endo I performed the surgical intervention; Tanaka K, Matsuyama R, Takeda K, and Matsuo K analyzed the data and Tanaka K wrote the manuscript.
Correspondence to: Kuniya Tanaka, MD, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. ktrj112@urahp.yokohama-cu.ac.jp
Telephone: +81-45-7872650 Fax: +81-45-7829161
Received: June 5, 2009
Revised: September 10, 2009
Accepted: September 17, 2009
Published online: October 31, 2009
Abstract

AIM: To clarify short- and long-term outcomes of combined resection of liver with major vessels in treating colorectal liver metastases.

METHODS: Clinicopathologic data were evaluated for 312 patients who underwent 371 liver resections for metastases from colorectal cancer. Twenty-five patients who underwent resection and reconstruction of retrohepatic vena cava, major hepatic veins, or hepatic venous confluence during hepatectomies were compared with other patients, who underwent conventional liver resections.

RESULTS: Morbidity was 20% (75/371) and mortality was 0.3% (1/312) in all patients after hepatectomy. Hepatic resection combined with major-vessel resection/reconstruction could be performed with acceptable morbidity (16%) and no mortality. By multivariate analysis, repeat liver resection (relative risk or RR, 5.690; P = 0.0008) was independently associated with resection/reconstruction of major vessels during hepatectomy, as were tumor size exceeding 30 mm (RR, 3.338; P = 0.0292) and prehepatectomy chemotherapy (RR, 3.485; P = 0.0083). When 312 patients who underwent a first liver resection for initial liver metastases were divided into those with conventional resection (n = 296) and those with combined resection of liver and major vessels (n = 16), overall survival and disease-free rates were significantly poorer in the combined resection group than in the conventional resection group (P = 0.02 and P < 0.01, respectively). A similar tendency concerning overall survival was observed for conventional resection (n = 37) vs major-vessel resection combined with liver resection (n = 7) performed as a second resection following liver recurrences (P = 0.09). Combined major-vessel resection at first hepatectomy (not performed; 0.512; P = 0.0394) and histologic major-vessel invasion at a second hepatectomy (negative; 0.057; P = 0.0005) were identified as independent factors affecting survival by multivariate analysis.

CONCLUSION: Hepatic resection including major-vessel resection/reconstruction for colorectal liver metastases can be performed with acceptable operative risk. However, such aggressive approaches are beneficial mainly in patients responding to effective prehepatectomy chemotherapy.

Keywords: Liver metastases; Colorectal cancer; Liver resection; Major-vessel resection