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Improved survival after resection of colorectal liver metastases
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Ahstracts./i'om Ann Surg Oncol
Improved Survival After Resection of Colorectal Liver Metastases George M. Fuhrman, MD, Steven A. Curley, MD, David C. Hohn, MD, and Mark S. Roh, MD
Background: The goal of this study was to determine if staging with intraoperative ultrasound (IOUS), assessment of porta hepatis lymph nodes, and evaluation of resection margins can improve selection of patients likely to benefit from resection of colorectal liver metastases. ' Methods: A retrospective evaluation was performed on patients undergoing celiotomy with intent to resect colorectal liver metastases.. Patients were considered unresectable if extrahepatic disease was identified by peritoneal exploration or if IOUS demonstated greater than four lesions or the inability to achieve negative margins. Tumor-negative margins were confirmed by pathologic evaluation. Actuarial 5-year survival was calculated using the method of Kaplan and Meier. Results: Median follow-up is 25 months. Of the 151 pati-e13ts undergoing operative exploration, 107 (71.0%) underwent liver resection (all margins tumor negative). Three operative deaths occurred in this group (2.8%). The disease of 30 patients (19.8%) was considered unresectable due to extrahepatic involvement, and that of 14 patients (9.2%) was demonstrated by IOUS to be unresectable. Five-year actuarial survival was 44% for the resected group and 0% for the unresectable patients (p < 0.0001). Conclusions: IOUS, portal node assessment, and pathologic margin evaluation improves the selection of patients likely to benefit from resection of colorectal liver metastases. Key Words: Colorectal c a n c e r - - L i v e r metastases--Liver resection--Intraoperative ultrasound.
Received August 25, 1994; accepted January 18, 1995. From the Department of Surgery, The Ochsner Clinic, New Orleans, Louisiana (G.M.F.), and Department of Surgical Ontology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (S.A.C., D.C.H., M.S.R.), USA. Address correspondence and reprint requests to Dr. George M. Fuhrman, Department of Surgery, The Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA 70121, USA. Presented at the 47th Annual Cancer Symposium of The Society of Surgical Ontology, Houston, Texas, March 17-20, 1994. Reproduced with permission from .,hm Surg Om'ol 1995; 2:537-541
Ahstracts./i'om Ann Surg Oncol
Improved Survival After Resection of Colorectal Liver Metastases George M. Fuhrman, MD, Steven A. Curley, MD, David C. Hohn, MD, and Mark S. Roh, MD
Background: The goal of this study was to determine if staging with intraoperative ultrasound (IOUS), assessment of porta hepatis lymph nodes, and evaluation of resection margins can improve selection of patients likely to benefit from resection of colorectal liver metastases. ' Methods: A retrospective evaluation was performed on patients undergoing celiotomy with intent to resect colorectal liver metastases.. Patients were considered unresectable if extrahepatic disease was identified by peritoneal exploration or if IOUS demonstated greater than four lesions or the inability to achieve negative margins. Tumor-negative margins were confirmed by pathologic evaluation. Actuarial 5-year survival was calculated using the method of Kaplan and Meier. Results: Median follow-up is 25 months. Of the 151 pati-e13ts undergoing operative exploration, 107 (71.0%) underwent liver resection (all margins tumor negative). Three operative deaths occurred in this group (2.8%). The disease of 30 patients (19.8%) was considered unresectable due to extrahepatic involvement, and that of 14 patients (9.2%) was demonstrated by IOUS to be unresectable. Five-year actuarial survival was 44% for the resected group and 0% for the unresectable patients (p < 0.0001). Conclusions: IOUS, portal node assessment, and pathologic margin evaluation improves the selection of patients likely to benefit from resection of colorectal liver metastases. Key Words: Colorectal c a n c e r - - L i v e r metastases--Liver resection--Intraoperative ultrasound.
Received August 25, 1994; accepted January 18, 1995. From the Department of Surgery, The Ochsner Clinic, New Orleans, Louisiana (G.M.F.), and Department of Surgical Ontology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (S.A.C., D.C.H., M.S.R.), USA. Address correspondence and reprint requests to Dr. George M. Fuhrman, Department of Surgery, The Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA 70121, USA. Presented at the 47th Annual Cancer Symposium of The Society of Surgical Ontology, Houston, Texas, March 17-20, 1994. Reproduced with permission from .,hm Surg Om'ol 1995; 2:537-541