Survival Outcomes of Patients with Colorectal Liver Metastases Following Hepatic Resection or Ablation in the Era of Effective Chemotherapy (original) (raw)

Abstract

The outcome of patients with colorectal liver metastases (CLM) undergoing surgical resection in the era of effective chemotherapy is not widely reported. In addition, factors associated with disease-specific survival (DSS) in a contemporary series of patients are not well defined. Clinical, pathologic, and outcome data for 64 patients with CLM treated by a single surgeon in a multidisciplinary setting from February 2002 to October 2007 were examined. Hepatic resection was combined with radiofrequency ablation (RFA) in 23 (36%) cases. Secondary or tertiary resection was undertaken in 12 (19%) patients. Synchronous CLM were noted in 25 (39%) cases. Neoadjuvant chemotherapy was given to 41 (64%) patients. Following hepatic resection, adjuvant chemotherapy was administered in 52 (81%) cases. There was one (2%) operative mortality. One or more complications were noted in 24 (38%) patients. Median length of hospital stay was 7 (2–7) days. Five-year DSS and overall survival were 72% and 69%, respectively**.** Bilobar disease (p < 0.001), local tumor extension (p = 0.02), response to neoadjuvant chemotherapy (p = 0.005), preoperative portal vein embolization (p = 0.05), number of hepatic lesions (p = 0.03), positive resection margin (p < 0.001), and node-positive primary disease (p = 0.001) were prognostically significant factors on univariate analysis. On multivariate analysis, bilobar disease (p = 0.02) and local tumor extension (p = 0.02) were the only two independent prognostic factors. We conclude that, in patients with CLM, a multidisciplinary approach encompassing an aggressive surgical policy achieves excellent 5-year survival results with acceptable operative morbidity and mortality. Bilobar disease and local extrahepatic extension of cancer appear to be independent prognostic factors for long-term survival.

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References

  1. Scheele J, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg. 1990;77:1241–6.
    Article PubMed CAS Google Scholar
  2. Wagner JS, Adson MA, Van Heerden JA, et al. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg. 1984;199:502–8.
    Article PubMed CAS Google Scholar
  3. Goldberg RM. Advances in the treatment of metastatic colorectal cancer. Oncologist. 2005;10 Suppl 3:40–8.
    Article PubMed Google Scholar
  4. Khatri VP, Chee KG, Petrelli NJ. Modern multimodality approach to hepatic colorectal metastases: solutions and controversies. Surg Oncol. 2007;16:71–83.
    Article PubMed Google Scholar
  5. Goldberg RM, Sargent DJ, Morton RF, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2004;22:23–30.
    Article PubMed CAS Google Scholar
  6. Maindrault-Goebel F, Tournigand C, Andre T, et al. Oxaliplatin reintroduction in patients previously treated with leucovorin, fluorouracil and oxaliplatin for metastatic colorectal cancer. Ann Oncol. 2004;15:1210–4.
    Article PubMed CAS Google Scholar
  7. Kemeny N. Presurgical chemotherapy in patients being considered for liver resection. Oncologist. 2007;12:825–39.
    Article PubMed CAS Google Scholar
  8. Scheele J, Altendorf-Hofmann A, Geoghegan JG, et al. Resection of colorectal liver metastases Treatment of colorectal liver metastases. Langenbecks Arch Surg. 1999;384:313–27.
    Article PubMed CAS Google Scholar
  9. Curley SA. Outcomes after surgical treatment of colorectal cancer liver metastases. Semin Oncol. 2005;32:S109–11.
    Article PubMed Google Scholar
  10. Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18; discussion 318–21.
    Google Scholar
  11. Rees M, Tekkis PP, Welsh FK, et al. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247:125–35.
    Article PubMed Google Scholar
  12. de Jong KP. Review article: multimodality treatment of liver metastases increases suitability for surgical treatment. Aliment Pharmacol Ther. 2007;26 Suppl 2:161–9.
    Google Scholar
  13. Adam R, Aloia T, Levi F, et al. Hepatic resection after rescue cetuximab treatment for colorectal liver metastases previously refractory to conventional systemic therapy. J Clin Oncol. 2007;25:4593–602.
    Article PubMed CAS Google Scholar
  14. Van Cutsem E, Nordlinger B, Adam R, et al. Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer. 2006;42:2212–21.
    Article PubMed Google Scholar
  15. Wicherts DA, de Haas RJ, Adam R. Bringing unresectable liver disease to resection with curative intent. Eur J Surg Oncol. 2007;33 Suppl 2:S42–51.
    PubMed CAS Google Scholar
  16. Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57; discussion 657–648.
    Article PubMed Google Scholar
  17. Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer. 1996;77:1254–62.
    Article PubMed CAS Google Scholar
  18. Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.
    Article PubMed CAS Google Scholar
  19. Adam R, Lucidi V, Bismuth H. Hepatic colorectal metastases: methods of improving resectability. Surg Clin North Am. 2004;84:659–71.
    Article PubMed Google Scholar
  20. Capussotti L, Muratore A, Mulas MM, et al. Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg. 2006;93:1001–6.
    Article PubMed CAS Google Scholar
  21. Giacchetti S, Itzhaki M, Gruia G, et al. Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol. 1999;10:663–9.
    Article PubMed CAS Google Scholar
  22. Mitry E, Fields A, Bleiberg H. Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer. A meta-analysis of two randomized trials. ASCO Annual Meeting Proceedings. J Clin Oncol. 2006;24:152 s.
    Article CAS Google Scholar
  23. Portier G, Elias D, Bouche O, et al. Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 trial. J Clin Oncol. 2006;24:4976–82.
    Article PubMed CAS Google Scholar
  24. Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol. 1997;15:938–46.
    PubMed CAS Google Scholar

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Authors and Affiliations

  1. Program for Liver, Pancreas and Foregut Tumors, Department of Surgery, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA, 17033-0850, USA
    Mehrdad Nikfarjam MD, PhD, Serene Shereef MD, Eric T. Kimchi MD, Niraj J. Gusani MD, Diego M. Avella MD & Kevin F. Staveley-O’Carroll MD, PhD
  2. Department of Medicine, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA, 17033-0850, USA
    Yixing Jiang MD, PhD
  3. Department of Radiology, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA, 17033-0850, USA
    Rickhesvar P. Mahraj MD

Authors

  1. Mehrdad Nikfarjam MD, PhD
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  2. Serene Shereef MD
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  3. Eric T. Kimchi MD
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  4. Niraj J. Gusani MD
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  5. Yixing Jiang MD, PhD
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  6. Diego M. Avella MD
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  7. Rickhesvar P. Mahraj MD
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  8. Kevin F. Staveley-O’Carroll MD, PhD
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Correspondence toKevin F. Staveley-O’Carroll MD, PhD.

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Nikfarjam, M., Shereef, S., Kimchi, E.T. et al. Survival Outcomes of Patients with Colorectal Liver Metastases Following Hepatic Resection or Ablation in the Era of Effective Chemotherapy.Ann Surg Oncol 16, 1860–1867 (2009). https://doi.org/10.1245/s10434-008-0225-3

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