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Liver surgery for colorectal liver metastasis has dramatically changed in recent years. A better knowledge of the natural history and biology of the primary tumor and a more thorough understanding of segmental liver anatomy are the major conceptual advancements. Also more effective diagnostic tools, such as serial carcinoembryonic antigen (CEA), preoperative and intraoperative ultrasound (US), CT scan, CT angioportography, and magnetic resonance imaging (MRI), have all contributed to earlier diagnosis and improved patient selection. Liver-sparing surgery (segmental approaches) using ultrasonic dissection techniques have also significantly decreased morbidity and mortality while still achieving improved radicality in the surgical resection of metastatic liver disease.

While hepatocellular carcinoma (HCC) is one of the world’s most common malignant neoplasms, with its highest prevalence in southeast Asia and portions of Africa, it remains a relatively rare malignancy in the western world. The incidence of concomitant cirrhosis is significantly higher in Asia, being over 70% [1–5] compared to less than 40% in western countries [6,7]. The overall 5-year survival after resection with curative intent in the West approaches 35–45% [8–10], whereas it ranges from 15% to 30% in the East [1, 2, 11, 12]. Recent implementation of mass screening programs using alphafeto protein and ultrasound in high-risk populations in Japan and China have identified increasing numbers of patients with small (

In this review of a collected series of patients undergoing hepatic resection for colorectal metastases, 100 patients were found to have survived greater than five years from the time of resection. Of these 100 long-term survivors, 71 remain disease-free through the last follow-up, 19 recurred prior to five years, and ten recurred after five years. Patient characteristics that may have contributed to survival were examined. Procedures performed included five trisegmentectomies, 32 lobectomies, 16 left lateral segmentectomies, and 45 wedge resections. The margin of resection was recorded in 27 patients, one of whom had a positive margin, nine of whom had a less than or equal to l-cm margin, and 17 of whom had a greater than 1-cm margin. Eighty-one patients had a solitary metastasis to the liver, 11 patients had two metastases, one patient had three metastases, and four patients had four metastases. Thirty patients had Stage C primary carcinoma, 40 had Stage B primary carcinoma, and one had Stage A primary carcinoma. The disease-free interval from the time of colon resection to the time of liver resection was less than one year in 65 patients, and greater than one year in 34 patients. Three patients had bilobar metastases. Four of the patients had extrahepatic disease resected simultaneously with the liver resection. Though several contraindications to hepatic resection have been proposed in the past, five-year survival has been found in patients with extrahepatic disease resected simultaneously, patients with bilobar metastases, patients with multiple metastases, and patients with positive margins. Five-year disease-free survivors are also present in each of these subsets. It is concluded that five-year survival is possible in the presence of reported contraindications to resection, and therefore that the decision to resect the liver must be individualized.