A Study of Prognostic Factors for Hepatic Resection for Colorectal Metastases* (original) (raw)
Related papers
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
Hepatic Resection for Colorectal Metastases—Selection of Cases and Determinants of Success
ANZ Journal of Surgery, 1987
Twenty-six patients undergoing hepatic resection for colorectal metastases have been followed for periods varying from I month to 8 years. The actuarial 5 year survival rate was just over 50% for all patients. Patients surviving for more than 2 years have been considered separately, and an attempt was made to determine what clinical factors determine whether a patient is likely to benefit from surgery or not. A stage I hepatic lesion. involvement of one rather than both lobes, the presence of less than four metastates and pathological proof that resection margins were free of tumour combined to define a group of patients with a 75% 5 year survival rate. The stage of the disease and the presence of unilobar metastases were the most important determinants of benefit. Patients demonstrating one or more unfavourable factors did not appear to benefit from hepatic resection.
Benefits and safety of hepatic resection for colorectal metastases
The American Journal of Surgery, 1999
BACKGROUND: Metastatic colorectal carcinoma to the liver is a potentially curable disease. The purpose of this study was to determine the safety and efficacy of hepatic resection for metastatic colorectal carcinoma. METHODS: One hundred twenty-one consecutive hepatic resections in 110 patients with metastatic colorectal cancer between January 1978 and September 1998 performed by a single surgeon were reviewed. RESULTS: The actuarial 5-year survival for all patients in the series was 46%. Of the patients operated on before 1993, the actual 5-year survival was 43% and actual disease-free 5-year survival was 28%. The actual 10-year survival was 27%, and of all patients operated on in the last 20 years, 48% are alive today. When comparing initial regional lymph node status, the 5-year survival was 54% for the patients with negative lymph nodes and 40% for patients with positive nodes. Only 18% of patients required a perioperative blood transfusion, and the median length of stay was 7 days. There were complications in 34% of cases, and the operative mortality was 4%.
Survival after hepatic resection for colorectal metastases: a 10-year experience
Annals of surgical …, 2006
Alice C. Wei, MD, MSc, FRCSC, Paul D. Greig, MD, FRCSC, David Grant, MD, FRCSC, Bryce Taylor, MD, FRCSC, Bernard Langer, MD, FRCSC, and Steven Gallinger, MD, MSc, FRCSC ... Hepatobiliary & Pancreatic Surgical Group, Divisions of General Surgery, University ...
Hepatic resections for colorectal metastases: The italian multicenter experience
Journal of Surgical Oncology, 1991
In 1989 there were 151,000 new cases of colorectal carcinoma in the United States. Approximately 50% of these patients will be at risk of developing liver metastases together with other sites of recurrence. However, the liver will be the main site of relapse in only 14,000 patients with colorectal cancer. [1,2,12,15,19]. Approximately 25% of patients with colorectal carcinoma have technically resectable hepatic metastases at the time of operation for primary lesion, and an additional 8–25% will develop metachronous hepatic metastases after primary resection [15,25].Recent reported experiences with surgical treatment of metastatic colorectal cancer in the liver seem to indicate that hepatic resection has become more acceptable, safe and effective therapy, and offers today when technically possible, the best prospect of survival in a conspicuous number of patients. For these reasons, although a prospective randomized trial has not been done comparing resection with nonresection, resection seems to give the best hope for cure and actually is the treatment of choice for selected patients. In fact in these patients is reported a significant prolongation of survival compared with those patients with unresectable liver metastases treated only with adjuvant therapy in the form of chemotherapy or radiation therapy.Median survival of resected patients with hepatic metastases has been reported to range from 6–12 months, and for patients with single metastases is reported to range from 4.5–6.2 months to 11 and 21 months [16,22,25,27].The benefits of surgical therapy have been emphasized by different experience, with a 5-year overall survival rate ranging from 20–40%. In a recent multicenter survey a 33% 5-year survival rate was demonstrated in 859 patients resected for hepatic metastases.
Hepatic resection for colorectal metastases – a national perspective
Annals of The Royal College of Surgeons of England, 2004
Background: Many consultant surgeons are uncertain about peri-operative assessment and postoperative follow-up of patients for colorectal liver metastases, and indications for referral for hepatic resection. The aim of this study was to assess the views the consultant surgeons who manage these patients. Methods: A postal questionnaire was sent to all consultant members of the Association of Coloproctology of Great Britain and Ireland and of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland. The questionnaire assessed current practice for preoperative assessment and follow-up of patients with colorectal malignancy and timing of and criteria for hepatic resection of metastases. Number of referrals/resections were also assessed. Results: The response rate was 47%. Half of the consultants held joint clinics with an oncologist and 89% assessed the liver for secondaries prior to colorectal resection. Ultrasound was used by 75%. Whilst 99% would consider referring a patient with a solitary liver metastasis for resection, only 62% would consider resection for more than 3 unilobar metastases. The majority (83%) thought resections should be performed within the 6 months following colorectal resection. During follow-up, 52% requested blood CEA levels and 72% liver ultrasound. Half would consider chemotherapy prior to liver resection and 76% performed at least one hepatic resection per year with a median number of 2 resections each year. Conclusions: A substantial proportion of patients are assessed for colorectal liver metastases preoperatively and during follow-up though there is spectrum of frequency of assessment and modality for imaging. Virtually all patients with solitary hepatic metastases are considered for liver resection. Patients with more than one metastasis are likely to be not considered for resection. Many surgeons are carrying out less than 3 resections each year.
Surgery, 1994
The selection of patients for resective therapy of hepatic colorectal metastases remains controversial. A number of clinical and pathologic prognostic risk factors have been variably reported to influence survival. Between January 1981 and December 1991, 204 patients underwent curative hepatic resection for metastatic colorectal cancer. Fourteen clinical and pathologic determinants previously reported to influence outcome were examined retrospectively. This led to a proposed TNM staging system for metastatic colorectal cancer (mTNM). No operative deaths occurred (death within 1 month). Overall 1-, 3-, and 5-year survivals were 91%, 43%, and 32%, respectively. Gender, Dukes' classification, site of primary colorectal cancer, histologic differentiation, size of metastatic tumor, and intraoperative blood transfusion requirement were not statistically significant prognostic factors (p > 0.05). Age of 60 years or more, interval of 24 months or less between colorectal and hepatic r...