Secondary Intrahepatic Spreadings of Hepatic Metastasis from Colorectal Carcinoma

Kazuyuki Takenami, Ken Takasaki, Masakazu Yamamoto

Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical College

Forty-three patients with hepatic metastasis from colorectal carcinoma were studied. The secondary intrahepatic spreading in the resected specimen was microscopically examined. The specimens were double stained with hematoxylin-eosine and Victoriablue, then four intrahepatic spreading modes were examined; liver parenchyma invasion, portal area invasion, hepatic vein involvement and satellite nodule. Thirty-one patients (72%) showed expansive growth, and of these patients 14 had capsule formation. Six of 12 patients with infiltrative growth had secondary liver parenchyma invasion through the portal area invasion. Thirty-eight patients (88.4%) had portal area invasion. In these patients, portal vein involvement was found in 31 and bile duct involvement in 17. Hepatic vein involvement was observed in 10 patients and satellite nodules were found in 28. Twenty-two satellite nodules were in the portal area and 6 were in the liver parechyma surrounding the main tumor. It was shown that 24 of the 28 satellite nodules (85.7%) were located within 1.5 cm distant from the main metastatic tumors. Furthermore, as the size of the main metastatic tumors increased, the distance and the incidence of satellite nodules tended to increase. All of the tumors less than 2 cm (7 cases) had portal area invasion. Metastatic hepatic carcinoma showed secondary intrahepatic spreading and the main invading pattern was portal area invasion. It is considered that anatomically systematized hepatic resection should be recommended as a surgical procedure not only for primary hepatic carcinoma but also for metastatic hepatic carcinoma.

Key words
secondary intrahepatic spreading of hepatic metastasis from colorectal carcinoma

Reprint requests
Kazuyuki Takenami Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical College
8-1 Kawada-cho, Shijuku-ku, Tokyo, 162 JAPAN

Accepted
October 9, 1996

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