Resection of liver metastases—When is it worthwhile?

Abstract

Most of what has been learned about resection of hepatic metastases comes from the study of colorectal cancer because such lesions are so common. One‐fourth or more of patients who have liver metastases from such lesions have hepatic tumors that can be removed, but only about 25% of these patients will live 5 years or more after such tumors have been removed. When resection so often fails to improve survival, there is a need to know when metastatic lesions should be removed. Study of determinants of prognosis, patterns of failure, and the natural history of the disease have shown that surgical failure is determined by the presence of extrahepatic metastases (even when removed) and limited resective margins. The patient's gender and the locoregional stage of the primary resected lesions influence survival, but not so much as to withhold resective treatment from these less favored groups. Studies of size, site, and number of hepatic metastases removed show therapeutic limitations associated with extremes, but these determinants of prognosis after resection must be studied in better ways. Although, at times, palliation is a reasonable goal, this aspect of resective treatment has not been studied well. When there are no good therapeutic alternatives to resection of hepatic metastases and when risk is low, such palliative operations may be justified. Only with further study will absolute contraindications to surgical therapy be well defined. There is an obvious need for biologic control of cancer.