Hepatic and Extrahepatic Colorectal Metastases: When Resectable, Their Localization Does Not Matter, But Their Total Number Has a Prognostic Effect (original) (raw)
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Journal of the American College of Surgeons, 2006
This study was done to determine the benefit of undergoing liver resection for noncolorectal metastasis. METHODS: A single-institution retrospective review of ali patienrs (n = 95) who underwenr hepatic resection for a noncolorectalliver metastasis from 1990 to 2005 was performed. Primary outcomes measure was monrhs of patienr survival afrer liver resection. RESULTS: Median patienr age was 58 years (range 19 to 83 years). There were 37 men (38.9%) and 58 women (61.1 %). The 30-day postoperative mortaliry rate was 2.1%, and postoperative complications developed in 15.8% of patienrs. Mean hospital stay was 7 days (range 4 to 25 days). Median time of survival from date ofliver resection was 36 monrhs, and 5-year survival rate was 34.9%. Primary tumor sites were idenrified as foregut or gastroinrestinal in 16.8% and nongastroinrestinal in 83.2%. Patienrs with a nonforegut primary tumor had a median survivaltime tWice as long as those with foregut primaries (49 months versus 20 months, p < 0.001). Multiple liver metastases were an independenr prognostic factor for worse outcomes with a hazard ratio of 3.3 (p = 0.007). No treatmenr-dependenr variables (initial rreatmenr modaliry, extenr of liver resection, margins, complications) were found on multivariable analysis to be importanr prognostic factors. CONCLUSIONS:In select patienrs with any of a variery of malignancies metastatic to the liver, prolonged survival can result from liver resection, especially in those with a single, resectable tumor from a nongastroinrestinal primary site.
Surgery in hepatic and extrahepatic colorectal metastases
Il Giornale di chirurgia
Extrahepatic disease (EHD) has been considered a contraindication to hepatectomy. Over the last few years, some series reported interesting 5-year survival rates after resection with hepatic colorectal metastases and EHD free margins. Between August 1989 and October 2005, 116 patients underwent liver resection for colorectal metastases at Surgical Department of the University of Udine, Italy. Among these, we reviewed the data of 5 patients affected by EHD. In 3 patients there were also an anastomotic recurrence of the primary tumor, in 3 patients diaphragm was infiltrated by contiguous liver metastases. We performed in all the patients minor liver resections. We have associated the radiofrequence ablation of a lesion not surgically resectable with liver resection in one case. The surgical procedure was always considered as curative. We observed no case of operative mortality. The mean survival of the entire cohort is 23.2 months (range 4-42 months). Our study, even if based upon a l...
Annals of Surgical Oncology, 2005
Background: The isolated occurrence of noncolorectal liver metastases is rare. The available data are inconsistent in terms of indication for surgery, treatment, and outcome, so a generally applicable therapeutic algorithm is currently lacking. Methods: A total of 162 patients underwent resection for noncolorectal liver metastases between 1978 and 2001. The patients were divided into two groups from different time periods (group 1, 1978-1989; group 2, 1990-2001) that were similar in terms of number of patients, operating surgeons, and surgical techniques used. The groups were compared, and the data were retrospectively analyzed with regard to indication, survival, and factors predictive for survival. Results: Resection was performed to remove liver metastases from noncolorectal gastrointestinal carcinoma (n = 50), neuroendocrine tumors (n = 12), genitourinary primary tumors (n = 11), breast carcinoma (n = 24), leiomyosarcoma (n = 15), and metastases from other primary cancers (n = 50). Extrahepatic tumor involvement was seen in 38 (23%) of the 162 cases. Sixty-two (38%) major hepatectomies and 100 (62%) minor resections were performed. In 100 (62%) of 162 patients, a curative resection (R0) could be achieved. Overall 2and 5-year survival rates of 49% and 26%, respectively, were observed, and the median survival was 23 months. Survival was significantly longer in patients who underwent an R0 resection. Conclusions: In selected patients, resection of noncolorectal liver metastases is associated with a 5-year survival rate of up to 50%. Resection of liver metastases from gastrointestinal adenocarcinomas correlates with a poor prognosis. Extrahepatic metastases may be considered a relative contraindication for liver resection.
Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases
British Journal of Surgery, 2003
Background Extrahepatic disease has always been considered an absolute contraindication to hepatectomy for liver metastases. The present study reports the long-term outcome and prognostic factors of patients undergoing resection of extrahepatic disease simultaneously with hepatectomy for liver metastases. Methods From January 1987 to January 2001, 111 (30 per cent) of 376 patients who had hepatectomy for colorectal liver metastases underwent simultaneous resection of extrahepatic disease with curative intent. Results Surgery was considered R0 in 77 patients (69 per cent) and palliative (R1 or R2) in 34 patients (31 per cent). The mortality rate was 4 per cent and the morbidity rate 28 per cent. After a median follow-up of 4·9 years, the overall 3- and 5-year survival rates were 38 and 20 per cent respectively. The 5-year overall survival rate of patients with R0 resection only (n = 75) was 29 per cent. The difference in survival between patients with and without extrahepatic disease...
Journal of Gastrointestinal Surgery, 2005
The aim of this study was to determine prognostic factors and outcome after liver resection for colorectal metastases in 102 patients over a period of 10 years. A stepwise procedure using proportional hazard regression analysis was used to identify prognostic factors. Estimated survival at 2 years was 71%, and at 5 years, 29% (Kaplan-Meier). Of 19 patients with isolated liver recurrence, 6 had a second metastasectomy; 4 of the 6 are still alive. We found that the number of hepatic lesions on computed tomography (P ϭ 0.012), the interval between resection of the primary colon tumor and the hepatic metastasectomy (P ϭ 0.012), and synchronicity of the primary and the hepatic metastasis (P ϭ 0.048) showed evidence of independent prognostic value regarding survival. Resection of hepatic colorectal metastases may result in long-term survival. Patients with recurrence after a first liver resection may benefit from a repeat metastasectomy. Our data suggest there is no strong predictor of survival. Survival seems to decrease with increasing number of metastases found on computed tomography. ( J GASTROINTEST SURG 2005;9:178-186) Ć 2005
Journal of Surgical Oncology, 2013
Background: The presence of extra-hepatic disease (EHD) is no longer an absolute contraindication to surgery in patients with colorectal liver metastases (CRLM). Recently, a novel prognostic model predicting overall survival in such patients was proposed using five risk factors (EHD other than isolated lung metastases, CEA !10 ng/ml, >5 liver metastases, right colon as the primary CRC location, and diagnosis of EHD concomitant to CRLM recurrence). A bi-institutional database was used to perform an external validation of this model. Methods: Ninety-seven patients operated for CRLM and EHD between 1982 and 2011 in two institutions was analyzed. The proposed prognostic model was validated in this cohort using Cox proportional hazards models and the concordance index (c). Results: Of the five proposed risk factors, only EHD other than isolated lung metastases was found to independently predict overall survival [Hazards Ratio (HR) ¼ 2.10 (95% CI: 1.01-4.40)]. Although, the number of risk factors was marginally associated with overall survival in univariate analysis (P ¼ 0.049), the performance of the proposed prognostic model was poor when applied to our cohort (c ¼ 0.64). Conclusion: The examined prognostic model of survival in patients with CRLM and EHD had poor performance. Further research is warranted to delineate the subset of patients who will benefit from surgery.
HPB : the official journal of the International Hepato Pancreato Biliary Association, 2016
Colorectal cancer (CRC) accounts for 9.7% of all cancers with 1.4 million new cases diagnosed each year. 19-31% of CRC patients develop colorectal liver metastases (CRLM), and 23-38% develop extra-hepatic disease (EHD). The aim of this systematic review was to determine overall survival (OS) in patients resected for CRLM and known EHD. A systematic review was undertaken to identify studies reporting OS after resection for CRLM in the presence of EHD. Proportional meta-analyses and relative risk of death before five years were assessed between patient groups. A total of 15,144 patients with CRLM (2308 with EHD) from 52 studies were included. Three and 5-year OS were 58% and 26% for lung, 37% and 17% for peritoneum, and 35% and 15% for lymph nodes, respectively. The combined relative risk of death by five years was 1.49 (95% CI = 1.34-1.66) for lung, 1.59 (95% CI = 1.16-2.17) for peritoneal and 1.70 (95% CI = 1.57-1.84) for lymph node EHD, in favour of resection in the absence of EHD....
Surgery, 2003
SURGERY 627 HEPATIC METASTASIS IS THE MOST COMMON distant site for metastatic disease in colorectal cancer, and more than half of the patients with recurrence after resection of colorectal cancer have hepatic metastasis develop. 1,2 During the last two decades, hepatic resection has been established as the standard therapy for hepatic metastasis of colorectal cancer, and it has been the only potentially curative treatment. 3,4 But frequent hepatic recurrence even after curative hepatic metastasectomy poses one of the major obstacles in the treatment of colorectal hepatic metastasis. Two thirds of patients who had undergone hepatectomy for colorectal hepatic metastasis had recurrent disease develop, and half of these patients with recurrent carcinoma had the disease recur in the remnant liver. Recently, repeat hepatic resection has been used for resectable lesion limited to the remnant liver, and several reports have shown excellent survival and therapeutic value of repeat hepatectomy, almost equal to those of initial hepatectomy. 5-8 The hepatic recurrence rate after repeat hepatic resection is, however, also high. Whether all patients with a resectable lesion limited to the remnant liver would benefit from repeat hepatectomy is questionable. If the patients with poor prognosis after repeat hepatectomy can be identified before surgery, they can receive a more aggressive treatment, such as combined surgical resection and chemotherapy, instead of repeat hepatectomy alone. Various prognostic factors have been reported for repeat hepatectomy, including shorter dis-