{ Cancer Treatment and Research i | _ Hepatobiliary Cancer edited by Paul H. Sugarbaker Kluwer Academic PublishersList of Contributors ABAUBARA, Sabas, M.D., University of Delaware, Life and Health Sciences, 123 Wolf Hall, Newark, DE 19716, USA ALDRETE, Joaquin, M.D., University of Alabama Hospital, Department of Surgery, 1922 7th Avenue, South, Birmingham, AL 35294, USA. ANDERSSON, Roland, M.D., Ph.D., Department of Surgery, Lund Uni- versity, S-221 85 Lund, Sweden ARCHER, Ann, M.D., Department of Radiology, Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010, USA ARNAUD, Jean-Pierre, M.D., Centre Hospitalier Regional et Universitaire D’Angers, Department of Surgery, 49033 Angers, France ASBUN, Horacio J., M.D., Lahey Clinic, 41 Mall Road, Burlington, MA 01805, USA AUGUST, David A., M.D., University of Michigan, Ann Arbor, MI 48109, USA AZURIN, Arturo, M.D., Mercy Hospital of Pittsburgh, 1400 Locust Street, Pittsburgh, PA 15219, USA BALLADUR, Pierre, M.D., De Chirurgia Digestive, Hospital Saint- Antoine, 184, rue du fg Saint-Antoine, 75571 Paris Cedex 12, France BERGAMASCHI, Roberto, M.D., Centre Hospitalier Regional et Univer- sitaire D’Angers, Department of Surgery, 49033 Angers, France BISMUTH, Henry, M.D., Hepatobiliary Unit, Hospital Paul Brousee, 14 Ave. P. Baillant Coutur., F-94800 Villejuir, France BLUMGART, Leslie, M.D., Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA BRAASCH, John W., M.D., Department of General Surgery, Lahey Clinic, 41 Mall Road, Burlington, MA 01805, USA ee Christoph, M.D., University of Chicago, Chicago, IL 60637, BROWER, Steven, M.D., Department of Surgery-Surgical Oncology, Mount Sinai Medical Center, One Gustave L Levy Place, New York, NY 10029-6574, USA16, Repeat liver resections from colorectal metastasi astasis vyjcente Fernéndez-Trigo, Falah Shamsa, and Resection Registry: Joaquin Aldrete, Roland Roberto Bergamaschi, Enrico Ciferri, Cruciti, Adamo Dagradi, Dominique El ww. John B. Basen. Reve S. Hughes, | Margaret Kemeny, Carlos Margarit, William Mi : Ma sesh Toes Nie Perea Fares Da, Schlag, Richard Stangl, Mark Steves, Paul H. Sugarbaker, Cornelive ele, Peter Velde, Joan Vidal-Jove ; PRR OEIC other members of the Repeat Hey a a Jean-Pierre iam fas, Mealy, Gene Coppa, Francesco : A Simo Gazzaniga, Lemuel Herrera. ‘ster Hohenberger, Duane Iistrup, atic Introduction 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 diag- nostic 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 diag- nosis 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. Several previous studies have reported the results of liver resections in Patients affected with colorectal hepatic metastasis [1-10]. Long-term sur- vival and disease-free survival rates reported are as high as 35% and 25%, respectively, when patients are carefully selected [1-10]. Several articles have reported the experience of single institutions with who have undergone repeated liver resections from colorectal malignancies [11-17]. It was clear that acceptable benefits in terms of long- term survival were achieved only in carefully selected patients. However, I ally small number of patients in these series preclude further more i it i tarted in 1991 try of Repeat Resection of Hepatic Metastasis was * aie, effort of 20 different institutions around the noni focused on liver surgery. The registry was able to are a co atients who had repeat liver resections for colorectal liver q ase ve study was carried out to determine the cies et pier i ions from colores ne repeated liver Fesreter™ sos likely t0 benefit from identify those patients who are fem. Consett © 1901. Bitter Arar Publisher,46. Repeat liver resections from colorectal metastasis Vicente Ferndndez-Trigo, Falah Shamsa, and other members of the Repeat Hepatic Resection Registry: Joaquin Aldretc, Roland Andersson, Jean-Pierre Arnaud Roberto Bergamaschi, Enrico Ciferri, David Connolly, Gene Coppa, Francesco Crucitti, Adamo Dagradi, Dominique Elias, Massimo Gazzaniga, Lemuel Herrera W. John B. Hodgson, Kevin S. Hughes, Peter Hohenberger, Duane Iistrup 4 Margaret Kemeny, Carlos Margarit, William Meyers, J. Enrique Murio, David M Nagorney, Nicola Nicoli, Thomas Nims, Florencia Que, Johannes Schecle, Peter Schlag, Richard Stangl, Mark Steves, Paul H. Sugarbaker, Cornelius J.H. van de Velde, Joan Vidal-Jove Introduction 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 diag- nostic 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 diag- nosis 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. Several previous studies have reported the results of liver resections in patients affected with colorectal hepatic metastasis [1~10]. Long-term sur- vival and disease-free survival rates reported are as high as 35% and 25%, Tespectively, when patients are carefully selected [1-10]. Several articles have reported the experience of single institutions with Patients who have undergone repeated liver resections from colorectal malignancies [11-17]. It was clear that acceptable benefits in terms of long- term survival were achieved only in carefully selected patients. However, the usually small number of patients in these series preclude further more accurate selection criteria. i i , A Registry of Repeat Resection of Hepatic Metastasis was started in 1991 with the cooperative effort of 20 different institutions around the world — especially focused on liver surgery. The registry was able to accrue a total of 170 patients who had repeat liver resections for colorectal liver metz A retrospective study was carried out to determine the outcome of pa who had undergone repeated liver resections from colorectal met disease and to identify those patients who are most likely to benefit Tepeat liver resection. P. Sugerbaker PATOBILIARY CANCER., Copyright (a ato All sgh tered, ISBN 0-723 © 1994. Kluwer 1 2901-X: