Specific Hepatic Lesions
Liver Metastases
Many cancers metastasize to the liver, from virtually all primary sites in the body, particularly those of GI tract origin. While metastatic disease in the liver often represents an incurable situation, there are exceptions. For example, resection of liver metastases from colorectal primary sites has produced reported 5-year survival rates as high as 58% in the MD Anderson Hospital surgical series, with long term survival seen in patients with greater than 3 lesions as well as those with more limited disease, as long as all metastatic disease is resected (4, 5, 6).
Other ablative therapies including radiofrequency ablation and cryotherapy have also produced extended survival in some patients with liver metastases, but compared with definitive resection, the 5-year disease free survival rate appears lower and the intrahepatic recurrence rate higher (4, 6, 9,10, 13, 14). In these reported series, an increased number of metastatic lesions did not necessarily predict inferior survival, though any metastatic deposit larger than 5 cm did predict decreased survival (9). Randomized trials of resection versus ablative therapies have not been reported.
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