Annals of Surgical Oncology

, Volume 11, Issue 3, pp 274–280 | Cite as

Results of R0 Resection for Colorectal Liver Metastases Associated With Extrahepatic Disease

  • Dominique Elias
  • Lucas Sideris
  • Marc Pocard
  • Jean-Francois Ouellet
  • Valérie Boige
  • Philippe Lasser
  • Jean-Pierre Pignon
  • Michel Ducreux
Original Articles


Background: Extrahepatic malignant disease has always been considered an absolute contraindication to hepatectomy for colorectal liver metastases. This study reports the long-term outcome and prognostic factors of patients undergoing extrahepatic disease resection simultaneously with hepatectomy for liver metastases.

Methods: From January 1987 to January 2001, 75 patients underwent a complete R0 resection of extrahepatic disease simultaneously with hepatectomy for colorectal liver metastases. They were inscribed in a registry and then prospectively followed up. They represented 25% of the 294 patients who underwent an R0 hepatectomy for colorectal liver metastases during the same period.

Results: The mortality rate was 2.7%, and morbidity was 25%. After a median follow-up of 4.9 years (range, 1.7–13.4 years), the overall 3- and 5-year survival rates were 45% and 28%, respectively. By using a Cox model, there was a significant difference in survival between patients with single versus multiple sites of extrahepatic disease. Also, the presence of more than five liver metastases was a significant parameter.

Conclusions: Extrahepatic disease in colorectal cancer patients with liver metastases should no longer be considered as a contraindication to hepatectomy. However, this intended R0 resection cannot be performed in 50% of laparotomized patients, and negative prognostic factors for surgery include the presence of multiple extrahepatic disease sites or more than five liver metastases.

Key Words

Liver metastases Colorectal Extrahepatic disease Surgery 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Surgery 1988;103:278–88.Google Scholar
  2. 2.
    Norlinger B, Jaeck D, Guignet M, Vaillant JC, Balladur P, Schaal JC. Résection chirurgicale des métastases hépatiques: enquête de l’Association Française de Chirurgie. Paris: Springer-Verlag, 1992:141–75.Google Scholar
  3. 3.
    Ekberg H, Tranberg KG, Andersson R, et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg 1986;73:727–31.PubMedGoogle Scholar
  4. 4.
    Cady B, McDermott WV Jr. Major hepatic resection for metachronous metastases from colon cancer. Ann Surg 1985;210:204–9.Google Scholar
  5. 5.
    Foster JH. Survival after liver resection for secondary tumors. Am J Surg 1978;135:389–94.PubMedGoogle Scholar
  6. 6.
    Adson MA. The resection of hepatic metastases. Another view. Arch Surg 1989;124:1023–4.PubMedGoogle Scholar
  7. 7.
    Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Analysis of 1001 consecutive cases. Ann Surg 1999;230:309–21.CrossRefPubMedGoogle Scholar
  8. 8.
    Jamison RL, Donohue JH, Nagorney DM, Rosen CB, Harmsen S, Ilstrup DM. Hepatic resection for metastatic colorectal cancer results in cure for some patients. Arch Surg 1997;132:505–11.PubMedGoogle Scholar
  9. 9.
    Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal metastases. World J Surg 1995;19:59–71.PubMedGoogle Scholar
  10. 10.
    Iwatsuki S, Dvorchick I, Madariaga J, et al. Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg 1999;189:291–9.PubMedGoogle Scholar
  11. 11.
    Pedersen IK, Bucharth F, Roikjaer O, Baden H. Resection of liver metastases from colorectal cancer. Indications and results. Dis Colon Rectum 1994;37:1078–82.PubMedGoogle Scholar
  12. 12.
    Minagawa M, Makuuchi M, Torzilli G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer. Ann Surg 2000;231:487–99.CrossRefPubMedGoogle Scholar
  13. 13.
    Filder IJ. Seed and soil revisited. Contribution of the organ microenvironment to cancer metastases. Surg Oncol Clin North Am 2001;10:257–69.Google Scholar
  14. 14.
    Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive surgery for prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 1998;14:254–61.PubMedGoogle Scholar
  15. 15.
    Elias D, Detroz B, Lasser P, Plaud B, Jerbi G. Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg 1995;169:254–60.PubMedGoogle Scholar
  16. 16.
    Elias D, Lasser P, Debaene B, et al. Intermittent exclusion of the liver without vena cava clamping during major hepatectomy. Br J Surg 1995;82:1535–9.PubMedGoogle Scholar
  17. 17.
    Takayama T, Makuuchi M, Kubota K, et al. Randomized comparison of ultrasonic versus clamp transection of the liver. Arch Surg 2001;136:922–8.PubMedGoogle Scholar
  18. 18.
    Elias D, Ouellet JF. Intraperitoneal chemohyperthermia: rationale, technique, indications, and results. Surg Oncol Clin North Am 2001;10:915–33.Google Scholar
  19. 19.
    Elias D, Blot F, El Otmany A, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 2000;92:71–6.Google Scholar
  20. 20.
    Schemper M, Smith TL. A note on quantifying follow-up in study of failure time. Control Clin Trials 1996;17:343–6.PubMedGoogle Scholar
  21. 21.
    Tsavellas G, Patel H, Aleen-Mersh TG. Detection and clinical significance of occult tumour cells in colorectal cancer. Review. Br J Surg 2001;88:1307–20.PubMedGoogle Scholar
  22. 22.
    Sadahiro S, Suzuki T, Tokunaga N, et al. Detection of tumor cells in the portal and peripheral blood of patients with colorectal carcinoma using competitive reverse transcriptase-polymerase chain reaction. Cancer 2001;92:1251–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Hansen E, Wolff N, Knuechel R, Ruschoff J, Hofstaedter F, Taeger K. Tumor cells in blood shed from the surgical field. Arch Surg 1995;130:387–93.PubMedGoogle Scholar
  24. 24.
    Oefelein MG, Kauk K, Herz B, et al. Molecular detection of prostate epithelial cells from the surgical field and peripheral circulation during radical prostatectomy. J Urol 1996;155:238–42.PubMedGoogle Scholar
  25. 25.
    Pollock RE, Roth JA. Cancer-induced immunosuppression: implications for therapy? Semin Surg Oncol 1989;5:414–9.PubMedGoogle Scholar
  26. 26.
    Kavanaugh DY, Carbone DP. Immunologic dysfunction in cancer. Hematol Oncol Clin North Am 1996;10:927–51.PubMedGoogle Scholar
  27. 27.
    Muss HB. Chemotherapy of Gynecologic Cancer. 2nd ed. New York: Wiley-Liss, 1990.Google Scholar
  28. 28.
    Rougier P, Van Custen E, Bajetta E, et al. Randomized trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet 1998;352:1407–12.CrossRefPubMedGoogle Scholar
  29. 29.
    Douillard JY, Cunningham D, Roth AD, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicenter randomized trial. Lancet 2000;355:1041–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Sugarbaker PH, Jablonski KH. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 1995;221:124–32.PubMedCrossRefGoogle Scholar
  31. 31.
    Adson MA. Resection of liver metastases: when is it worthwhile? World J Surg 1987;11:511–20.PubMedGoogle Scholar
  32. 32.
    Elias D, Ouellet JF, Bellon N, Pignon JP, Pocard M, Lasser P. Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg 2003;90:567–74.CrossRefPubMedGoogle Scholar
  33. 33.
    Elias D, Ouellet JF. Incidence, distribution, and significance of hilar lymph node metastases in hepatic colorectal metastases. Surg Oncol Clin North Am 2003;12:221–9.Google Scholar
  34. 34.
    Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol 1997;15:938–46.PubMedGoogle Scholar
  35. 35.
    Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002;20:1248–59.CrossRefPubMedGoogle Scholar
  36. 36.
    Elias D, Maisonnette F, Druet-Cabanac M, et al. An attempt to clarify indications for hepatectomy for liver metastases from breast cancer. Am J Surg 2002;185:158–64.Google Scholar
  37. 37.
    Sugarbaker PH. Intraperitoneal chemotherapy for treatment and prevention of peritoneal carcinomatosis and sarcomatosis. Dis Colon Rectum 1994;37(Suppl):S115–22.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2004

Authors and Affiliations

  • Dominique Elias
    • 1
    • 4
  • Lucas Sideris
    • 1
  • Marc Pocard
    • 1
  • Jean-Francois Ouellet
    • 1
  • Valérie Boige
    • 2
  • Philippe Lasser
    • 1
  • Jean-Pierre Pignon
    • 3
  • Michel Ducreux
    • 2
  1. 1.Departments of Surgical OncologyGustave Roussy InstituteVillejuifFrance
  2. 2.Departments of Medical OncologyGustave Roussy InstituteVillejuifFrance
  3. 3.Departments of Biostatistics and EpidemiologyGustave Roussy InstituteVillejuifFrance
  4. 4.Department of Surgery, Division of Surgical OncologyGustave Roussy InstituteVillejuif CEDEXFrance

Personalised recommendations