Maximal debulking liver resection as a beneficial treatment strategy for advanced and aggressive colorectal liver metastases

Background: A survival benefit is generally considered unobtainable following incomplete hepatic resection in patients with colorectal liver metastases. However, this question should be readdressed considering recent chemotherapy, often combining a monoclonal antibody directed against colorectal cancer with various classic and improved strategies. We examined whether a survival benefit could be obtained from maximal reduction surgery for colorectal liver metastases. Patients and Methods: We retrospectively analyzed data from 165 patients with liver recurrence after hepatectomy for colorectal metastases. Results: We hypothesized that recurrence soon after surgery, frequently involved metastases left behind during liver resection, resembling the situation after debulking hepatectomy. When patients were divided according to time of liver recurrence, patients with early recurrence had significantly poorer overall survival than those with later recurrence (p<0.01). However, patients with multiple bilobar metastases (n=77), having a greater likelihood of metastases left behind at hepatectomy, had similar survival whether recurrence was early or late (p=0.13). Response to chemotherapy before first hepatectomy was prognostically important (relative risk of 0.107; p=0.02) for patients with early liver recurrence, as were number of recurrent tumors and status of extrahepatic disease. Conclusion: Debulking surgery for multiple bilobar metastases may represent a treatment strategy with potential survival benefit, especially when initial metastases respond well to pre-hepatectomy chemotherapy.