Abstract
BackgroundAlthough numerous prognostic factors have been reported for colorectal cancer liver metastasis (CRLM), few studies have reported intraoperative blood loss (IBL) effects on clinical outcome after CRLM resection.MethodsWe retrospectively evaluated the clinical and histopathological characteristics of 139 patients who underwent liver resection for CRLM. The IBL cutoff volume was calculated using receiver operating characteristic curves. Overall survival (OS) and recurrence free survival (RFS) were assessed using the Kaplan–Meier and Cox regression methods.ResultsAll patients underwent curative resection. The median follow up period was 25.0 months (range, 2.1–88.8). Body mass index (BMI) and CRLM number and tumor size were associated with increased IBL. BMI (P=0.01; 95% CI = 1.3–8.5) and IBL (P<0.01; 95% CI = 1.6–12.5) were independent OSOs predictors. Five factors, including IBL (P=0.02; 95% CI = 1.1–4.1), were significantly related to RFS via multivariate Cox regression analysis. In addition, OSOs and RFS significantly decreased with increasing IBL volumes. The 5-year OSOs of patients with IBL≤250, 250–500, and >500mL were 71%, 33%, and 0%, respectively (P<0.01). RFS of patients within three IBL volumes at the end of the first year were 67%, 38%, and 18%, respectively (P<0.01).ConclusionsIBL during CRLM resection is an independent predictor of long term survival and tumor recurrence, and its prognostic value was confirmed by a dose–response relationship.
Highlights
The liver is the most common target organ of distant colorectal cancer metastasis. 20%-25% percentage points newly diagnosed patients present with synchronous liver metastases and approximately 50% patients develop metachronous liver metastases after radical resection for primary colorectal cancer [1,2]
Several studies have focused on the relationship between intraoperative blood loss (IBL) during liver surgery for hepatocellular carcinoma (HCC) and postoperative outcome and reported that IBL was an independent prognostic factor [10], but few studies have been devoted to cancer liver metastasis (CRLM)
Growing evidence has suggested that hepatic resection is the only current potentially curative therapy against liver metastases of colorectal origin [13,14]
Summary
The liver is the most common target organ of distant colorectal cancer metastasis. 20%-25% percentage points newly diagnosed patients present with synchronous liver metastases and approximately 50% patients develop metachronous liver metastases after radical resection for primary colorectal cancer [1,2]. Comprehensive management with curative liver resection for colorectal cancer liver metastasis (CRLM) offers a 5-year survival rate of up to 58% [7,8,9]. In the present study, we evaluated the influence of IBL during liver resection for CRLM on tumor recurrence and long term survival. Numerous prognostic factors have been reported for colorectal cancer liver metastasis (CRLM), few studies have reported intraoperative blood loss (IBL) effects on clinical outcome after CRLM resection. Methods: We retrospectively evaluated the clinical and histopathological characteristics of 139 patients who underwent liver resection for CRLM. Conclusions: IBL during CRLM resection is an independent predictor of long term survival and tumor recurrence, and its prognostic value was confirmed by a dose–response relationship
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