Treatment strategy for patients with multiple liver metastases of colorectal origin in the era of adjuvant chemotherapy

: A treatment strategy that includes adjuvant chemotherapy needs to be developed for the treatment of patients with multiple liver metastases of colorectal origin. Of the 91 patients who underwent initial hepatic resection for colorectal liver metastases, we reviewed the clinical courses of 10 patients who had 7 or more metastatic liver nodules. Twenty-one, 19, 17, and 9 metastases were initially resected in each of the 4 patients, and 7 metastases were resected in each of the remaining 6 patients. Portal vein embolization was performed in 3 patients, 2 of whom underwent two-stage hepatectomy. Adjuvant chemotherapy was administered to all the 10 patients. Recurrence was detected in all the 10 patients; however, in 6 of these patients, liver was the only site of recurrence. Repeated hepatic resection was performed in 5 of the 6 patients. As of the mean follow-up period of 25 months, 4 patients were alive and cancer-free, 4 were undergoing chemotherapy, and 2 had died of their cancer. Improvement in the survival outcome of patients with 7 or more colorectal liver metastases can be expected by treating them with adjuvant chemotherapy in addition to aggressive surgical procedures, including extended hemihepatectomy, portal venous embolization, two-stage hepatectomy, and repeated resection.