Outcomes after surgical treatment of colorectal cancer liver metastases.

Many patients with metastatic colorectal cancer present with liver-only disease that is amenable to surgical resection. While patients with more than three or four hepatic metastases have traditionally been considered poor candidates for surgical treatment, a review of extant data shows that a sizable proportion of these patients can have long-term survival with surgical intervention. Our group performed a prospective study in 418 patients with proven liver-only disease to determine outcomes with resection alone and with resection plus radiofrequency ablation (RFA) or RFA alone in patients with unresectable disease. Overall 5-year survival was significantly greater in patients receiving resection alone, but 4-year survival rates were substantial in patients receiving resection plus RFA or RFA alone (P <.0001); survival with the latter two approaches was significantly better than that with chemotherapy alone (P = .0017). Although the presence of more than three metastases was associated with a significantly increased risk of death compared with a solitary metastasis on multivariate analysis, patients with more than three metastases had a 5-year survival rate in excess of 50%. Surgical resection and ablation should be considered as part of a multimodality therapeutic approach to both primary and secondary hepatic malignancies.