Abstract
ABSTRACT Background:About 50% of the patients with colorectal adenocarcinoma will present with liver metastasis and 20% are synchronic. Liver resection is associated with improvement in survival in comparison to chemotherapy alone. Aim:To analyze the overall survival in patients submitted to liver resection of colorectal cancer metastasis and prognostic factors related to the primary and secondary tumors. Methods:A retrospective analysis of a prospectively maintained database regarding demographic, primary tumor and liver metastasis characteristics. Results:There were 84 liver resections due to colorectal cancer metastasis in the period. The 5-year disease-free and overall survivals were 27.5% and 48.8% respectively. The statistically significant factors for survival were tumor grade (p=0.050), lymphovascular invasion (p=0.021), synchronous metastasis (p=0.020), as well as number (p=0.004), bilobar distribution (p=0.019) and diameter of the liver metastasis over 50 mm (p=0.027). Remained as independent negative predictive factors: lymphovascular invasion (HR=2.7; CI 95% 1.106-6.768; p=0.029), synchronous metastasis (HR=2.8; CI 95% 1.069-7.365; p=0.036) and four or more liver metastasis (HR=1.7; CI 95% 1.046-2.967; p=0.033). Conclusion:The resection of liver metastasis of colorectal adenocarcinoma leads to good survival rates. Lymphovascular invasion was the single prognostic factor related to the primary tumor. Synchronous disease and four or more metastasis were the most significant factors related to the secondary tumor.
Highlights
It is expected that about 50% of the patients with colorectal adenocarcinoma will present with liver metastasis, 20% being diagnosed synchronous with the primary tumor[3,6,8,28]
Liver resection presents with a 5-year overall survival between 24% and 64% in comparison with 10% to 11% of systemic chemotherapy alone . 1,9,10,13,19,21,22,23,30 Currently, patients with technically resectable nodules, a sufficient liver remnant, no or limited extra-hepatic disease and those considered fit to be submitted to major abdominal surgery are considered candidates for resection, though this accounts for only 20% of all metastatic patients[22,27]
The aim of this study was to describe the overall survival in patients submitted to resection of colorectal liver metastasis (CRLM) and to describe predictive prognostic factors related to the primary and secondary tumors
Summary
It is expected that about 50% of the patients with colorectal adenocarcinoma will present with liver metastasis, 20% being diagnosed synchronous with the primary tumor[3,6,8,28]. The main prognostic factors for overall survival after hepatic resection of colorectal metastasis are based on classical papers published between 1960 and 20009,10,13,18,21. More recent publications failed to demonstrate adequate accuracy of these variables in current population[13,21,27]. Much of this disparity is attributed to widespread and improvement in chemotherapy, better patient selection and advancements in surgical techniques. A great number of these prognostic factors are related to the hepatic disease and not to the primary tumor. The aim of this study was to describe the overall survival in patients submitted to resection of colorectal liver metastasis (CRLM) and to describe predictive prognostic factors related to the primary and secondary tumors
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