An attempt to clarify indications for hepatectomy for liver metastases from XXXX .

@entity1 @entity204 @entity0
BACKGROUND: Liver metastases (LM) from @entity0 are generally considered as disseminated disease with a poor prognosis. However in selected @entity1 hepatectomy may be an important adjunct to systemic treatment. METHODS: Fifty-four @entity0 @entity1 (mean age 49.2 +/- 5.2 years) with LM as the sole site of metastatic disease (except for bone metastases in 3 @entity1 ) underwent hepatectomy between 1986 and 2000. The mean number of LM was 4.0 +/- 8. All @entity1 presented either a stable disease or an objective response to chemotherapy. The last 25 @entity1 also underwent hepatic artery catheter installation in order to receive postoperative hepatic artery infusion chemotherapy (HAIC). RESULTS: The postoperative morbidity was 12.9%. There was no postoperative mortality. R0 and R1-R2 resections were obtained in, respectively, 81.5% and 18.5% of @entity1 . After a median follow-up of 32 months the median survival was 34 +/- 9 months, with 3- and 5-year overall survival rates of 50% and 34%, and 3- and 5-year disease-free survival rates of 42% and 22%, respectively. The number of LM, the presence of hilar lymph nodes (33%), and the completeness of resection had no significant prognostic impact. The only factor influencing survival in both the univariate and multivariate analysis was the hormone receptor status (P = 0.03): the relative risk of @entity204 was increased by 3.5-fold when negative. In the HAIC group, the liver recurrence rate decreased from 60.5% to 31.2% without any impact on global survival. CONCLUSIONS: Hepatectomy is beneficial for selected @entity1 with isolated LM. Indications should be based more on technical (low operative risk, probable R0 resection) than on oncologic criteria. The decision is simple for young @entity1 but more difficult for older @entity1 in whom a negative hormone receptor status appears to be a contraindication.
