대한대장항문학회

Hepatic resection of metastatic colorectal cancer has a proven role in those patients<br>with isloated hepatic metastasis. In order to evaluate the therapeutic results<br>and<br>determine the prognostic factors, 21 patients who underwent hepatic resection<br>for<br>metastatic colorectal cancer between Jan. 1950 to June. 1990 at Department of Surgery,<br>Seoul National University, were analyzed. Sixteen of these patients(76.2%) had<br>metastasis limited to one lobe and 5 patients(23.8 %) had metastasis involving both<br>lobes. Eleven Patients(52.4%) had a solitary metastasis, while 10(47.6%) had 2 or more<br>metastatic deposits. Mean size of the metastatic lesions was 2.8 cm. Of 21 Patients,<br>13(61.9% ) had synchronous metastasis at the time of initial operation, and 8(38%) had<br>metachronous metastasis diagnosed between 3 months to 36 months after<br>initial<br>operation. Fourteen Patients(66.7%) had Dukes' C Primary tumor. Ten Patients(47.6%)<br>had their original tumor located in rectums followed by sigmoid colon in 5(23.8%) and<br>ascending colon in 4(19.1%). Sixteen Patients(76.2%) had well-differentiated<br>adenocarcinoma, and3(14.3%) had moderately differentiated adenocarcinomas.<br>Wedge resection was performed in 9 patients(42.9%), followed by subsegmentectomy<br>in 5(23.8 % ), segmentectomy in 5(23.8%), and lobectomy in 2 patients(9.5%). Minor<br>postoperative complications occured in 4 patients(19.1%), but there was no operative<br>mortality.<br>Using Kaplan and Meier method, median survival of these 21 patients were 41<br>months. By log-rank test, pathologic stage of the primary cancer of the colon and<br>rectum(p= 0.020), and whether the patient had metastasis involving only one lobe or<br>both lobes of the liver(p=0.015), significantly influenced the survival with those patients<br>with Dukes' C Primary tumor and bilateral lobar involovement showing poor prognosis<br>compared to those with Dukes' B primary tumor and metastasis confined to a single<br>lobe. Location of the primary tumor, number and size of metastatic nodules, cell type of<br>the primary tumor, Preoperative serum CEA values, age, sex and whether the patient<br>had synchronous or metachronous metastasis, did not influence the overall outcome.<br>Our data suggest that hepatic resection for metastatic colorectal coancer is relative<br>safe procedure with good survival benefit to patients. More aggressive surgical attitude<br>towards hepatic metastasis from colorectal cancer is warranted.<br>