The presence of extrahepatic disease synchronous to colorectal liver metastases was long considered a contraindication to resection. However, in recent series good survival rates after radical hepatic and extrahepatic resection have been reported and were higher than expected after chemotherapy alone. Portal lymph nodes involvement occurs in about 15% of patients and is a negative prognostic factor. Lymph node metastases confined to the hepatic pedicle are no longer a contraindication to resection, although preoperative chemotherapy is recommended. In patients with celiac or retroperitoneal positive lymph nodes, the indications for resection are controversial. Resection in the presence of peritoneal carcinomatosis should be considered only in well selected patients with limited resectable peritoneal deposits. Pulmonary metastases should be aggressively resected whenever possible, even if synchronous to liver metastases, as good long-term results are possible.


Liver Metastasis Liver Resection Peritoneal Carcinomatosis Colorectal Liver Metastasis Extrahepatic Disease 
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  1. 1.
    Cady B, McDermott WV (1985) Major hepatic resection for metachronous metastases from colon cancer. Ann Surg 210:204–209CrossRefGoogle Scholar
  2. 2.
    Foster JH (1978) Survival after liver resection for secondary tumors. Am J Surg 135:389–394CrossRefPubMedGoogle Scholar
  3. 3.
    Adson MA (1989) The resection of hepatic metastases. Another view. Arch Surg 124:1023–1024PubMedGoogle Scholar
  4. 4.
    Elias D, Ouellet JF, Bellon N et al (2003) Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg 90:567–574CrossRefPubMedGoogle Scholar
  5. 5.
    Elias D, Sideris L, Pocard M et al (2004) Results of R0 resection for colorectal liver metastases associated with extrahepatic disease. Ann Surg Oncol 11:274–280CrossRefPubMedGoogle Scholar
  6. 6.
    Carpizo DR, Are C, Jarnagin W et al (2009) Liver resection for metastatic colorectal cancer in patients with concurrent extrahepatic disease: results in 127 patients treated at a single center. Ann Surg Oncol 16:2138–2146CrossRefPubMedGoogle Scholar
  7. 7.
    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: 309–318CrossRefPubMedGoogle Scholar
  8. 8.
    Beckurts KT, Holscher AH, Thorban S et al (1997) Significance of lymph node involvement at the hepatic hilum in the resection of colorectal liver metastases. Br J Surg 84:1081–1084CrossRefPubMedGoogle Scholar
  9. 9.
    Elias D, Saric J, Jaeck D et al (1996) Prospective study of microscopic lymph node involvement of the hepatic pedicle during curative hepatectomy for colorectal metastases. Br J Surg 83:942–945CrossRefPubMedGoogle Scholar
  10. 10.
    Laurent C, Sa Cunha A, Rullier E et al (2004) Impact of microscopic hepatic lymph node involvement on survival after resection of colorectal liver metastasis. J Am Coll Surg 198:884–891CrossRefPubMedGoogle Scholar
  11. 11.
    Ercolani G, Grazi GL, Ravaioli M et al (2004) The role of lymphadenectomy for liver tumors: further considerations on the appropriateness of treatment strategy. Ann Surg 239:202–209CrossRefPubMedGoogle Scholar
  12. 12.
    Grobmyer SR, Wang L, Gonen M et al (2006) Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy. Ann Surg 244: 260–264CrossRefPubMedGoogle Scholar
  13. 13.
    Jaeck D, Nakano H, Bachellier P et al (2002) Significance of hepatic pedicle lymph node involvement in patients with colorectal liver metastases: a prospective study. Ann Surg Oncol 9:430–438CrossRefPubMedGoogle Scholar
  14. 14.
    Adam R, de Haas RJ, Wicherts DA et al (2008) Is hepatic resection justified after chemotherapy in patients with colorectal liver metastases and lymph node involvement? J Clin Oncol 26:3672–3680CrossRefPubMedGoogle Scholar
  15. 15.
    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
  16. 16.
    Ekberg H, Tranberg KG, Andersson R et al (1986) Determinants of survival in liver resection for colorectal secondaries. Br J Surg 73:727–731CrossRefPubMedGoogle Scholar
  17. 17.
    Rosen CB, Nagorney DM, Taswell HF et al (1992) Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg216:493–504CrossRefPubMedGoogle Scholar
  18. 18.
    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
  19. 19.
    Bennett JJ, Schmidt CR, Klimstra DS et al (2008) Perihepatic lymph node micrometastases impact outcome after partial hepatectomy for colorectal metastases. Ann Surg Oncol 15:1130–3116CrossRefPubMedGoogle Scholar
  20. 20.
    Jayne DG, Fook S, Loi C et al (2002) Peritoneal carcinomatosis from colorectal cancer. Br J Surg 89:1545–1550CrossRefPubMedGoogle Scholar
  21. 21.
    Yan TD, Black D, Savady R et al (2006) Systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. J Clin Oncol 24:4011–4019CrossRefPubMedGoogle Scholar
  22. 22.
    Verwaal VJ, van Ruth S, de Bree E et al (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 21:3737–3743CrossRefPubMedGoogle Scholar
  23. 23.
    Sugarbaker PH (1998) Intraperitoneal chemotherapy and cytoreductive surgery for prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 14:254–261CrossRefPubMedGoogle Scholar
  24. 24.
    Glehen O, Kwiatkowski F, Sugarbaker PH et al (2004) Cytoreductive surgery combined with intraperitoneal chemotherapy for management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study J Clin Oncol 22:3284–3292CrossRefPubMedGoogle Scholar
  25. 25.
    Elias D, Benizri E, Pocard M et al (2006) Treatment of synchronous peritoneal carcinomatosis and liver metastases from colorectal cancer. Eur J Surg Oncol 32:632–636CrossRefPubMedGoogle Scholar
  26. 26.
    Kianmanesh R, Scaringi S, Sabate JM et al (2007) Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases. Ann Surg 245:597–603CrossRefPubMedGoogle Scholar
  27. 27.
    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
  28. 28.
    Pfannschmidt J, Dienemann H, Hoffmann H (2007) Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series. Ann Thorac Surg 84:324–338CrossRefPubMedGoogle Scholar
  29. 29.
    Ashley AC, Deschamps C, Alberts SR (2006) Impact of prognostic factors on clinical outcome after resection of colorectal pulmonary metastases. Clin Colorectal Cancer 6:32–37CrossRefPubMedGoogle Scholar
  30. 30.
    Miller G, Biernacki P, Kemeny NE et al (2007) Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg 205:231–238CrossRefPubMedGoogle Scholar
  31. 31.
    Regnard JF, Grunenwald D, Spaggiari L et al (1998) Surgical treatment of hepatic and pulmonary metastases from colorectal cancers. Ann Thorac Surg 66:214–218CrossRefPubMedGoogle Scholar
  32. 32.
    Headrick JR, Miller DL, Nagorney DM et al (2001) Surgical treatment of hepatic and pulmonary metastases from colon cancer. Ann Thorac Surg 71:975–979CrossRefPubMedGoogle Scholar
  33. 33.
    Kobayashi K, Kawamura M, Ishihara T (1999) Surgical treatment for both pulmonary and hepatic metastases from colorectal cancer. J Thorac Cardiovasc Surg 118:1090–1096CrossRefPubMedGoogle Scholar
  34. 34.
    Shah SA, Haddad R, Al-Sukhni W et al (2006) Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma. J Am Coll Surg 202:468–475CrossRefPubMedGoogle Scholar
  35. 35.
    Nagakura S, Shirai Y, Yamato Y et al (2001) Simultaneous detection of colorectal carcinoma liver and lung metastases does not warrant resection. J Am Coll Surg 193:153–160CrossRefPubMedGoogle Scholar
  36. 36.
    Mineo TC, Ambrogi V, Tonini G et al (2003) Longterm results after resection of simultaneous and sequential lung and liver metastases. J Am Coll Surg 197:386–391CrossRefPubMedGoogle Scholar
  37. 37.
    Reddy RH, Kumar B, Shah R et al (2004) Staged pulmonary and hepatic metastasectomy in colorectal cancer-is it worth it? Eur J Cardiothorac Surg 25:151–154CrossRefPubMedGoogle Scholar
  38. 38.
    Neeff H, Hörth W, Makowiec F et al (2009) Outcome after resection of hepatic and pulmonary metastases of colorectal cancer. J Gastrointest Surg. 13:1813–1820CrossRefPubMedGoogle Scholar
  39. 39.
    Byam J, Reuter NP, Woodall CE et al (2009) Should hepatic metastatic colorectal cancer patients with extrahepatic disease undergo liver resection/ablation? Ann Surg Oncol 6:3064–3069CrossRefGoogle Scholar
  40. 40.
    de Haas RJ, Rahy Martin AC, Wicherts DA et al (2009) Long-term outcome in patients with adrenal metastases following resection of colorectal liver metastases. Br J Surg 96:935–940CrossRefPubMedGoogle Scholar

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© Springer-Verlag Italia 2011

Authors and Affiliations

  • Roberto Lo Tesoriere
    • 1
  1. 1.Division of Hepato-Bilio-Pancreatic and Digestive SurgeryMauriziano “Umberto I” HospitalTurinItaly

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