[What are indications for hepatic resection in metastases?].

INTRODUCTION

In the last 20 years the resection of liver metastases became the method of choice in the therapy of malignant tumors, particularly of colorectal cancer. The study was aimed at evaluating indication criteria and operation tactics in liver metastases resection.

MATERIALS AND METHODS

The authors retrospectively analyzed a group of 154 patients subjected to liver resection for metastases, having been operated on since 1980 to May 2003. The preoperative indication procedure included a) imaging examination of the liver (CT, NMR, DSA--radiological staging), b) evaluation of tolerance to liver resection to liver resection (ASA, hem-coagulation tests, liver tests, nutritional state), c) examination to exclude the occurrence of extrahepatic tumor (imaging and endoscopic methods). In addition to peroperative examination (surgical staging) and selective vascular exclusion in anatomical resection, the standard operation procedure was supplemented in the last five years with transaction of the liver by means of the harmonic scalpel. From the total number, metastases of colorectal cancer were resected in 116 patients, in 20 gall bladder cancers, in 6 stomach cancers, in 4 breast cancers, in three carcinoids of colon and intestine and in two kidney cancers. Individual patients suffering from metastases of adrenal cancer, pancreas cancer and melanoma, respectively, were also operated on. More extensive anatomical resections were performed in 44 patients, segmentectomy was made in 43 subjects and non-anatomical wedge-shaped resections in 67 individuals.

RESULTS

Postoperative complications occurred in 15 (9.8%) patients (subphrenic hematoma, abscess, cholascos, fluidothorax, pulmonary or early infection). Two patients died within 30 days (1.3%) for hemorrhagic shock due to bleeding from duodenal ulcer and from hepatorenal failure).

CONCLUSION

1. Liver resection is indicated is resectable metastases of colorectal cancer. 2. The resection exerts a therapeutic effect in non-colorectal metastases in neuroendocrine tumors, tumor of uropoetic and genital system, breast cancer, sarcoma and melanoma. 3. The preoperative diagnosis should include: a) imaging examination of the liver and the site of primary tumor and possible occurrence of other metastases, b) determination of tolerance to liver resection. 4. The operation tactics includes the peroperative evaluation of operability, radical resection of metastases with 1 cm border of unaffected liver tissue and procedures leading to diminished blood loss and biliary stasis. 5. Anatomical resection is indicated in larger metastases affecting segments of one lobe. Non-anatomical wedge-shaped resection is aimed at removal of peripheral foci.