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The potential to increase curative liver resection rates in metastatic colorectal cancer.

Across Europe colorectal carcinoma remains second only to lung cancer as the cause of death from malignant disease. Of the 17 000 or so British patients with colorectal cancer who each year either progress after supposedly curative resection of their primary tumour or present with advanced, disseminated disease, less than 1000 are considered for liver resection (personal audit of UK practice for and on behalf of the British Society of Gastroenterology and presented to the 1999 Spring Scientific Meeting of the BSG). Hepatectomy offers the only chance of cure and is successful in nearly one-third of cases. Unfortunately, by conventional criteria (followed by most general and colorectal surgeons) barely 10% of patients presenting with liver metastases are considered amenable to surgical resection. These criteria include less than four metastases, unilobar distribution, tumours smaller than 5 cm in diameter and tumours resectable with at least a 1 cm resection margin of healthy liver tissue. Relative traditional contraindications to resection have included synchronous detection of primary and metastatic disease and Dukes' C stage primary tumours (compared with dukes' stages A and B). Recent long-term (10 year follow-up) analyses have, however, suggested that the number and distribution of metastases are not that important as factors in determining outcome. Furthermore, the extent of the resection margin of healthy liver beyond the metastasis (previously held to be greater than 1 cm) does not now seem to be as important as previously thought. Contrary to previously held views, prehepatectomy serum CEA levels might not have an