Abstract
BackgroundHepatectomy is recommended as the most effective therapy for liver metastasis from colorectal cancer (CRCLM). It is crucial to elucidate the prognostic clinicopathological factors.MethodsEighty-three patients undergoing initial hepatectomy for CRCLM were retrospectively analyzed with respect to characteristics of primary colorectal and metastatic hepatic tumors, operation details and prognosis.ResultsThe overall 5-year survival rate after initial hepatectomy for CRCLM was 57.5%, and the median survival time was 25 months. Univariate analysis clarified that the significant prognostic factors for poor survival were depth of primary colorectal cancer (≥ serosal invasion), hepatic resection margin (< 5 mm), presence of portal vein invasion of CRCLM, and the presence of intra- and extrahepatic recurrence. Multivariate analysis indicated the presence of intra- and extrahepatic recurrence as independent predictive factors for poor prognosis. Risk factors for intrahepatic recurrence were resection margin (< 5 mm) of CRCLM, while no risk factors for extrahepatic recurrence were noted. In the subgroup with synchronous CRCLM, the combination of surgery and adjuvant chemotherapy controlled intrahepatic recurrence and improved the prognosis significantly.ConclusionsOptimal surgical strategies in conjunction with effective chemotherapeutic regimens need to be established in patients with risk factors for recurrence and poor outcomes as listed above.
Highlights
Hepatectomy is recommended as the most effective therapy for liver metastasis from colorectal cancer (CRCLM)
Included were: tumor location, tumor differentiation, number of lymph nodes metastasis, depth of tumor invasion in the colorectal wall (≤ ss (a1) or ≥ se (a2); ss, sub-serosa; se, serosa; a1, sub-adventitia; a2, adventitia), lymphatic invasion, venous invasion, and Duke’s stage; the only significant difference in survival rate was observed between patients with primary CRC ≤ ss (a1) and those with ≥ se (a2) in the colorectal wall (P = 0.0133)
While untreated CRCLM has a poor prognosis with median survival ranging from 6 to 12 months and is not expected to be over 5 years, long-term survival and potential for cure following surgical resection for CRCLM had been demonstrated in numerous uncontrolled studies [7,8,12]
Summary
Hepatectomy is recommended as the most effective therapy for liver metastasis from colorectal cancer (CRCLM). Despite recent improvements in the diagnosis and management of colorectal cancer (CRC), which have enabled early detection followed by early treatment, many advanced cases with hepatic or peritoneal metastasis are still encountered. For further improvement of the prognosis of CRC, it is important to prolong the survival of these advanced cases with distant metastasis. Hepatectomy for liver metastasis from colorectal cancer (CRCLM) is recommended as the most effective therapy [1,2,3,4,5,6,7,8,9,10,11]. The aim of this study was to retrospectively investigate surgical outcomes in a consecutive series of patients undergoing hepatectomy for CRCLM at a single institution, in order to analyze recurrence patterns and clinicopathological prognostic factors for survival
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