Evolution of Resectability Criteria

  • Andrea Muratore


Surgical resection is the gold standard in the treatment of colorectal liver metastases. Extension of the indications has, not surprisingly, determined an increase in the recurrence rates, underlining the need for appropriate selection of those patients who may benefit most from surgery. However, literature data suggest that the presence of any combination of pre-operative factors should not be used as an absolute contraindication to resection. Instead, colorectal liver metastases should be treated by resection whenever liver resection is technically feasible, with curative intent.


Liver Metastasis Liver Resection Resection Margin Hepatic Resection Colorectal Liver Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wagner JS, Adson MA, Van Heerden JA et al (1984) The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg 199:502–507CrossRefPubMedGoogle Scholar
  2. 2.
    Fortner JG, Silva JS, Golbey RB et al (1984) Multivariate analysis of a personal serie of 247 consecutive patients with liver metastases from colorectal cancer. Treatment by hepatic resection. Ann Surg 199:307–316Google Scholar
  3. 3.
    Scheele J, Stangl R, Altendorf-Hofmann A (1990) Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 77:1241–1246CrossRefPubMedGoogle Scholar
  4. 4.
    Abdalla EK, Vauthey JN, Ellis LM et al (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239(6):818–825; discussion 825-827CrossRefPubMedGoogle Scholar
  5. 5.
    Capussotti L, Muratore A, Mulas MM et al (2006) Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg 93:1001–1006CrossRefPubMedGoogle Scholar
  6. 6.
    Ekberg H, Tranberg JG, Andersson R et al (1986). Determinants of survival in liver resection for colorectal secondaries. Br J Surg 73:727–731CrossRefPubMedGoogle Scholar
  7. 7.
    Steele G, Ravikumar TS (1989) Resection of hepatic metastases from colorectal cancer. Bioologic perspectives. Ann Surg 212:127–138CrossRefGoogle Scholar
  8. 8.
    Hughes KS, Rosenstein RB, Songhrabodi S et al (1988) Resection of the liver for colorectal carcinoma metastases. A multi-institutional study of long-term survivors. Dis Colon Rectum 31:1–4CrossRefPubMedGoogle Scholar
  9. 9.
    Pawlik TM, Scoggins CR, Zorzi D et al (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241:715–724CrossRefPubMedGoogle Scholar
  10. 10.
    Adam R, Pascal G, Castaing D et al (2004). Tumor progression while on chemotherapy. A contraindication to liver resection for multiple colorectal metastases? Ann Surg 240:1052–1064CrossRefPubMedGoogle Scholar
  11. 11.
    Nordlinger B, Guiguet M, Balladur P et al (1996) Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Cancer 77:1254–1262CrossRefPubMedGoogle Scholar
  12. 12.
    Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Analysis of 1001 consecutive cases. Ann Surg 230:309–321CrossRefPubMedGoogle Scholar
  13. 13.
    Viganò L, Ferrero A, Lo Tesoriere R et al (2008) Liver surgery for colorectal liver metastases: results after 10 years of follow up. Long-term survivors, late recurrences, and prognostic role of morbidity. Ann Surg Oncol 15:2458–2464CrossRefPubMedGoogle Scholar
  14. 14.
    D’Angelica M, Brennan MF, Fortner JG et al (1997) Ninety-six five-year survivors after liver resection for metastatic colorectal cancer. J Am Coll Surg 185:554–559CrossRefPubMedGoogle Scholar
  15. 15.
    Minagawa M, Makuuchi M, Torzilli G et al (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer. Long-term results. Ann Surg 231:487–499CrossRefPubMedGoogle Scholar
  16. 16.
    Oussoultzoglou E, Romain B, Panaro F et al (2009) Long-term survival after liver resection for colorectal liver metastases in patients with hepatic pedicle lymph nodes involvement in the era of new chemotherapy regimens. Ann Surg 249:879–886CrossRefPubMedGoogle Scholar
  17. 17.
    Elias D, Gilly F, Boutitie F et al (2010) Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol 28:63–68CrossRefPubMedGoogle Scholar
  18. 18.
    Viganò L, Capussotti L, Laurent C et al (2010) Is progression while on neoadjuvant chemotherapy always a contraindication to liver resection for colorectal metastases? HPB 12S1:109–110Google Scholar
  19. 19.
    Neumann UP, Thelen A, Rocken C et al (2009) Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases. Surgery 146:52–59CrossRefPubMedGoogle Scholar
  20. 20.
    Kishi Y, Abdalla EK, Chun YS et al (2009) Three hundred and one consecutive extended right hepatectomies. Evaluation of outcome based on systematic liver volumetry. Ann Surg 250:540–548Google Scholar
  21. 21.
    Ferrero A, Viganò L, Polastri R et al (2007) Postoperative liver dysfunction and future remnant liver where is the limit? Results of a prospective study. World J Surg 31:1643–1651CrossRefPubMedGoogle Scholar
  22. 22.
    Charnsangavej C, Clary B, Fong Y et al (2006) Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 13:1261–1268CrossRefPubMedGoogle Scholar
  23. 23.
    Elias D, Cavalcanti A, Sabourin JC et al (1998) Results of 136 curative hepatectomies with a safety margin of less than 10 mm for colorectal metastases. J Surg Oncol 69:88–93CrossRefPubMedGoogle Scholar
  24. 24.
    Adam R, Delvart V, Pascal G, et al (2004) Rescue surgey for unresectable colorectal liver metastases downstaged by chemotherapy. A model to predict long-term survival. Ann Surg 240:644–658CrossRefPubMedGoogle Scholar
  25. 25.
    Charnsangavej C, Clary B, Fong Y et al (2006) Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 13:1261–1268CrossRefPubMedGoogle Scholar
  26. 26.
    Are C, Gonen M, Zazzali K et al (2007) The impact of margins on outcome after hepatic resection for colorectal metastases. Ann Surg 246:295–300CrossRefPubMedGoogle Scholar
  27. 27.
    Konopke R, Kersting S, Makowiec F et al (2008) Resection of colorectal liver metastases: is a resection margin of 3 mm enough? World J Surg 32:2047–2056CrossRefPubMedGoogle Scholar
  28. 28.
    Nuzzo G, Giuliante F, Ardito F et al (2008) Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience. Surgery 143:384–393CrossRefPubMedGoogle Scholar
  29. 29.
    Muratore A, Ribero D, Zimmitti G et al (2010) Resection margin and recurrence-free survival after liver resection of colorectal metastases. Ann Surg Oncol 17:1324–1329CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • Andrea Muratore
    • 1
  1. 1.Division of Hepato-Bilio-Pancreatic and Digestive SurgeryMauriziano “Umberto I” HospitalTurinItaly

Personalised recommendations