RESUMEN
PURPOSE: Surgical resection is still considered as the gold standard in patients with hepatic metastases from colorectal cancer. The impact of the number of hepatic metastases is a controversial issue. We aimed to evaluate the outcomes and the prognostic factors after hepatic resection in multiple hepatic metastases from colorectal cancer. METHODS: Between June 1989 and October 2005, 42 patients underwent hepatic resections for three or more hepatic metastases from colorectal cancer. Disease-free survival analyses were performed on patients grouped as a function of the following factors: age, sex, preoperative serum CEA level, primary tumor site, nodal status, intrahepatic distribution, diameter of the liver lesion, their number, and the resection margin. RESULTS: Of the 42 patients, 29 (69.0%) developed recurrence (16 in the liver alone, 5 in the liver and another distant site, 8 in a distant site alone) during a median follow-up of 24 months. The overall 1-, 2-, and 5-year survival rates were 89.1%, 58.6%, and 31.8%, respectively. The 1-year and 2-year disease-free survival rates were 38.1 and 29.4%, respectively. There was no postoperative mortality and the morbidity rate was 11.9%. The disease-free survival rate was independently associated with the resection margin of the metastatic tumor (P=0.017). The 1-year disease- free survival rates in patients with more than a 5-mm resection margin and with less than a 5-mm resection margin were 72.7%, and 25.8%, respectively. CONCLUSIONS: If technically feasible, an aggressive hepatic resection should be performed for the treatment of multiple hepatic metastases from colorectal cancer. The surgical resection margin may govern the outcomes in patients with surgically curable hepatic metastases from colorectal cancer.