Surgical Resection of Colorectal Liver Metastases in Patients with Expanded Indications: A Single-Center Experience with 501 Patients Juan Figueras, M.D., 1 Jaume Torras, M.D., 1 Carlos Valls, M.D., 2 Laura Llado, M.D., 1 Emilio Ramos, M.D., 1 Joan Marti-Rague ´, M.D., 1 Teresa Serrano, M.D., 3 Juan Fabregat, M.D. 1 1 Department of Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain 2 Department of Radiology, Hospital Universitari de Bellvitge, Barcelona, Spain 3 Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain PURPOSE: This study was designed to investigate survival after curative resection of colorectal liver metastases in patients with expanded indications. METHODS: A total of 501 patients had 545 liver resections for metastatic colorec- tal cancer. There were no predefined criteria for resectability with regard to the number or size of the tumors, locore- gional invasion, or extrahepatic disease, except that resec- tion had potential to be complete and macroscopically curative. All patients who had curative hepatic resection were advised to start postoperative adjuvant chemotherapy. RESULTS: A total of 259 patients had expanded indications (52 percent), including 14 with liver metastases >10 cm, 194 with bilateral deposits, 140 with four or more liver metastases, and 73 with extrahepatic disease. The overall actuarial survival rates at one, three, five, and ten years were 88, 67, 45, and 36 percent, respectively, for patients with classic indications and 84, 53, 34, and 24 percent, respec- tively, for patients with expanded indications (P = 0.0009). In the group of expanded indications, there were more patients who received preoperative than postoperative chemotherapy: 72 (28 percent) vs. 18 (7 percent; P < 0.0001), and 148 (70 percent) vs. 131 (61 percent; P = 0.0466). In a multivariate analysis, four or more liver metastases and extrahepatic disease were independent predictors of poor outcome. Adjuvant chemotherapy signi- ficantly improved survival (P = 0.0002). CONCLUSIONS: This study suggested that liver resection should be indicated in patients with expanded indications. The extent of the benefits of preoperative and postoperative chemotherapy needs to be quantitated. [Key words: Hepatectomy; Liver neoplasm (surgery); Liver neoplasm (secondary); Neoplasm metastasis; Survival rate; Liver diseases (surgery); Adjuvant chemotherapy; Comparative study] H epatic resection is the most effective treatment option available for patients with metastases from colorectal carcinoma (CRC) limited to the liver and with no extrahepatic disease. 1 Several large series have reported a 25 to 40 percent long-term survival rate after curative resection of liver metasta- ses (LM), whereas the long-term survival rate without therapy is <2 percent. 2–6 Traditionally, only approx- imately 10 to 20 percent of patients with LM have been considered eligible for surgery (<4 tumors, unilobar, <5 cm in size without extrahepatic dis- ease). 2 The remaining 80 to 90 percent of patients are unsuited for surgery and receive palliative treatment. Chemotherapy for patients with advanced CRC has dramatically increased the response rate to 50 Presented at the European Hepato-Pancreato-Biliary Association (EHPBA), Heidelberg, Germany, May 26 to 28, 2004. Correspondence to: Juan Figueras, M.D., Servicio de Cirugı ´a General y Digestiva, IdIBGi, Hospital de Girona Josep Trueta, C/ Franc ¸a s/n., Girona E-17007, Spain, e-mail: cgd.jfigueras@htrueta. scs.es Dis Colon Rectum 2007; 50: 478–488 DOI: 10.1007/s10350-006-0817-6 * The American Society of Colon and Rectal Surgeons Published online: 5 February 2007 478