Surgical Resection of Liver Metastases
Numerous studies have also demonstrated that surgical resection can result in long-term survival for patients with hepatic colorectal metastases. From 25% to 35% of patients who undergo liver resection for colorectal metastases can be expected to survive for five years, with median survival of 28 to 40 months. Read the online reviews here , here and here.

Other data on surgical resection for liver mets: here, here, here, here, here, here

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see CA Cancer J Clin 1999;49:231-255

In three series, follow-up has been sufficiently long to document a 10-year survival rate of approximately 20% after liver resection for patients with hepatic colorectal metastases.These results should be compared with results of no treatment, where median survivals of six to 12 months are expected and five-year survival is rare. These results can also be compared with the best chemotherapy results, where median survival is expected to be 12 to18 months, and five-year survivors are rare. Patients in good general health, with technically resectable metastatic disease limited to the liver, should be considered for resection.

The variables most consistently associated with tumor recurrence and therapeutic failure are: (1) tumor involvement in the resection margin,and (2) detection of extrahepatic disease at the time of treatment of liver metastases. Any metachronous colorectal lesion or anastomotic recurrences may be resected at the time of liver resection. Extrahepatic metastases found at any other intra-abdominal site usually rule out a liver resection, as the prognosis is poor and cure unlikely, regardless of treatment. Disseminated pulmonary metastases are also contraindications to liver resection, although efforts to aggressively resect limited pulmonary metastases along with the liver metastases have met with reasonable success.

Some of the other variables associated with recurrence and therapeutic failure after liver resection include: Regional lymph node involvement by the primary tumor, symptomatic liver tumors,synchronous presentation of liver metastases with the primary tumor, large numbers of tumors, presence of satellite nodules, high preoperative carcinoembryonic antigen (CEA) level, and extent of liver involvement of more than 50%  have all been reported to predict recurrence.

In our recent analysis of 456 consecutive liver resections,the following factors were associated with poor prognosis: (1) size of liver tumors greater than 5 cm; (2) disease-free interval between colon and liver disease of less than 12 months; (3) number of liver tumors greater than one; (4) lymph-node-positive primary tumor; and (5) preoperative CEA level of greater than 200 ng/ml. Nevertheless, as the presence of any one of these characteristics was still associated with five-year survival rates between 24% and 34%, none can be considered an absolute contraindication to resection. Increasing number of these negative prognostic indicators was associated with increasing risk of recurrence. We have developed a clinical risk score based on these five criteria that shows promise in improving patient selection for surgery (see figure).

Age, gender,primary tumor grade, and location  have not consistently been demonstrated to affect outcome. At present, extrahepatic disease and inability to resect all hepatic disease are the only absolute contraindications to resection. All medically fit patients with completely resectable disease confined to the liver should, therefore, be considered for resection. As extensive resections of up to 80% of the liver parenchyma can be performed with less than a 4% mortality rate at major centers, we have adopted an increasingly aggressive approach to resection. We are routinely resecting bilobar tumors, as well as livers with up to 10 tumors.