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Laura A. Lambert, MD; Thomas A. Colacchio, MD; Richard J. Barth, Jr, MD

Arch Surg. 2000;135:473-480.

Hypothesis  Interval reevaluation for resectability of hepatic colorectal metastases aids patient selection.

Design  A retrospective review.

Setting  A tertiary care medical center.

Patients and Methods  From January 1, 1985, to July 1, 1998, 318 patients with colorectal hepatic metastases were identified. Resectable lesions (N=73) were divided into synchronous (n=36) or metachronous (n=37) and retrospectively reviewed for immediate resection or interval reevaluation. Kaplan-Meier survival curves of treatment groups were compared by the log-rank test.

Results  Survival curves of patients with synchronous and metachronous lesions undergoing interval reevaluation vs immediate resection were not significantly different (P=.74 and P=.65, respectively). No lesions from patients who underwent interval reevaluation became unresectable due to growth of the initial metastases. After interval reevaluation, 8 (29%) of 28 patients with synchronous metastases were spared the morbidity of laparotomy because of distant or an increased number of metastases and 10 (36%) of 28 patients were spared the morbidity of hepatic resection at the time of interval laparotomy. Actuarial median and 5-year survival of patients after delayed hepatic resection (51 months and 45%, respectively) were significantly improved compared with those of all other patients with resectable metastases (23 months and 7%, respectively) (P=.02). For patients with metachronous lesions who underwent interval reevaluation, 4 (29%) of 14 patients were spared the morbidity of laparotomy because of an increased number of hepatic or distant metastases.

Conclusions  Delaying hepatic resection for metastatic colorectal cancer does not impair survival. Potentially, two thirds of patients can avoid major hepatic surgery. For synchronous metastases, delaying hepatic resection appears to select patients who will benefit from hepatic resection.

From the Section of General Surgery, Dartmouth-Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, NH.

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