1. ¹Cancer Research UK Clinical Centre, MP824, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
2. ²University Surgery, F Level Centre Block (MP816), Southampton General Hospital, Southampton SO16 6YD, UK
3. ³Department of Clinical and Surgical Sciences, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, Scotland EH16 4SA, UK
4. ⁴Department of Surgery, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK
5. ⁵Hepatobiliary Surgery Unit, North Hampshire Hospital, Aldermaston Road, Basingstoke RG24 9NA, UK

Correspondence: Professor JN Primrose, E-mail: j.n.primrose@soton.ac.uk

Received 2 November 2005; Revised 7 February 2006; Accepted 7 February 2006; Published online 14 March 2006.

Abstract

No consensus on the indications for surgical resection of colorectal liver metastases exists. This systematic review has been undertaken to assess the published evidence for its efficacy and safety and to identify prognostic factors. Studies were identified by computerised and hand searches of the literature, scanning references and contacting investigators. The outcome measures were overall survival, disease-free survival, postoperative morbidity and mortality, quality of life and cost effectiveness, and a qualitative summary of the trends across all studies was produced. Only 30 of 529 independent studies met all the eligibility criteria for the review, and data on 30-day mortality and morbidity only were included from a further nine studies. The best available evidence came from prospective case series, but only two studies reported outcomes for all patients undergoing surgery. The remainder reported outcomes for selected groups of patients: those undergoing hepatic resection or those undergoing curative resection. Postoperative mortality rates were generally low (median 2.8%). The majority of studies described only serious postoperative morbidity, the most common being bile leak and associated perihepatic abscess. Approximately 30% of patients remained alive 5 years after resection and around two-thirds of these are disease free. The quality of the majority of published papers was poor and ascertaining the benefits of surgical resection of colorectal hepatic metastases is difficult in the absence of randomised trials. However, it is clear that there is group of patients with liver metastases who may become long-term disease- free survivors following hepatic resection. Such survival is rare in apparently comparable patients who do not have surgical treatment. Further work is needed to more accurately define this group of patients and to determine whether the addition of adjuvant treatments results in improved survival.