Abstract
Background
Liver surgery is the gold-standard treatment of colorectal liver metastases. Five-year survival rates may be inadequate to evaluate surgical outcomes because some patients are alive with recurrence and late recurrences are possible. The aim of this study was to analyze 10-year survival outcome in terms of late recurrence rate and prognostic factors of survival.
Methods
One hundred twenty-five patients underwent liver resection for colorectal liver metastases between 1985 and 1996. Four patients who experienced postoperative mortality were excluded. The analysis was performed on 121 patients.
Results
Five- and 10-year survival rates were 23.1% and 15.7%, respectively. Nineteen patients were alive 10 years after liver resection and 17 were disease-free (5 after re-resection). Five- and 10-year disease-free survival rates were 17.4% and 14.8%, respectively. In patients with recurrence, re-resection significantly improved survival (P < 0.001); 98% of recurrences occurred within the first 5 years, but 15% of patients disease-free at 5 years developed later recurrence. Multivariate analysis evidenced five independent negative prognostic factors of survival: male sex (P = 0.029), synchronous metastases (P = 0.011), >3 metastases (P < 0.001), metastatic infiltration of nearby structures (P < 0.001), and postoperative morbidity (P < 0.001). In 17 patients without negative prognostic factors the 10-year survival rate was 35.3%.
Conclusion
Liver resection for colorectal liver metastases may be curative in more than one-third of patients without negative prognostic factors. Postoperative morbidity significantly worsens long-term outcomes. The risk of recurrence after liver resection is high even after 5 years of follow-up, but re-resection can improve the outcome.
Similar content being viewed by others
References
Pawlik TM, Choti MA. Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg 2007; 11:1057–77
Simmonds PC, Primrose JN, Colquitt JL, et al. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 2006; 94:982–99
Wagner JS, Adson MA, Van Heerden JA, et al. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg 1984; 199:502–8
Scheele J, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 1990; 77:1241–6
Minagawa M, Makuuchi M, Torzilli G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 2000; 231:487–99
D’Angelica M, Brennan MF, Fortner JG, et al. Ninety-six five-year survivors after liver resection for metastatic colorectal cancer. J Am Coll Surg 1997; 185:554–9
Tanaka K, Shimada H, Ueda M, et al. Long-term characteristics of 5-year survivors after liver resection for colorectal metastases. Ann Surg Oncol 2007; 14:1336–46
Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Analysis of 1001 consecutive cases. Ann Surg 1999; 230:309–21
Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004; 240:644–57
Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 2007; 25:4575–80
Capussotti L, Muratore A, Mulas MM, et al. Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg 2006; 93:1001–6
Elias D, Debaere T, Muttillo I, et al. Intraoperative use of radiofrequency treatment allows an increase in the rate of curative liver resection. J Surg Oncol 1998; 67:190–1
Pawlik TM, Izzo F, Cohen DS, et al. Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann Surg Oncol 2003; 10:1059–69
Pawlik TM, Scoggins CR, Zorzi D, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 2005; 241:715–22
Fernandez FG, Drebin JA, Linehan DC, et al. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 2004; 240:438–47
Zakaria S, Donohue JH, Que FG, et al. Hepatic resection for colorectal metastases: value for risk scoring systems? Ann Surg 2007; 246:183–91
Muratore A, Polastri R, Bouzari H, et al. Repeat hepatectomy for colorectal liver metastases: a worthwhile operation? J Surg Oncol 2001; 76:127–32
Adam R, Bismuth H, Castaing D, et al. Repeat hepatectomy for colorectal metastases. Ann Surg 1997; 225:51–62
Fernandez-Trigo V, Shamsa F, Sugarbaker PH, et al. Repeat liver resections from colorectal metastasis. Surgery 1995; 117:296–304
Petrowsky H, Gonen M, Jarnagin W, et al. Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis. Ann Surg 2002; 235:863–71
Adam R, Pascal G, Azoulay D, et al. Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 2003; 238:871–83
Imamura H, Kawasaki S, Miyagawa S, et al. Aggressive surgical approach to recurrent tumors after hepatectomy for metastatic spread of colorectal cancer to the liver. Surgery 2000; 127:528–35
Miller G, Biernacki P, Kemeny NE, et al. Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg 2007; 205:231–8
Yedibela S, Klein P, Feuchter K, et al. Surgical management of pulmonary metastases from colorectal cancer in 153 patients. Ann Surg Oncol 2006; 13:1538–44
Elias D, Sideris L, Pocard M, et al. Results of R0 resection for colorectal liver metastases associated with extrahepatic disease. Ann Surg Oncol 2004; 11:274–80
Tanaka K, Adam R, Shimada H, et al. Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver. Br J Surg 2003; 90:963–9
Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Française de Chirurgie. Cancer 1996; 77:1254–62
Ekberg H, Tranberg KG, Andersson R, et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg 1986; 73:727–31
Stephenson KR, Steinberg SM, Hughes KS, et al. Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases. Ann Surg 1988; 208:679–87
Capussotti L, Viganò L, Ferrero A, et al. Timing of resection of liver metastases synchronous to colorectal tumor: proposal of prognosis-based decisional model. Ann Surg Oncol 2007; 14:1143–50
Moroz P, Salama PR, Gray BN. Resecting large numbers of hepatic colorectal metastases. ANZ J Surg 2002; 72:5–10
Hirai T, Yamashita Y, Mukaida H, et al. Poor prognosis in esophageal cancer patients with postoperative complications. Surg Today 1998; 28:576–9
Fujita S, Teramoto T, Watanabe M, et al. Anastomotic leakage after colorectal cancer surgery: a risk factor for recurrence and poor prognosis. Jpn J Clin Oncol 1993; 23:299–302
de Melo GM, Ribeiro KC, Kowalski LP, et al. Risk factors for postoperative complications in oral cancer and their prognostic implications. Arch Otolaryngol Head Neck Surg 2001; 127:828–33
Mynster T, Christensen IJ, Moesgaard F, et al. Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer. Danish RANX05 Colorectal Cancer Study Group. Br J Surg 2000; 87:1553–62
Panis Y, Ribeiro J, Chrétien Y, et al. Dormant liver metastases: an experimental study. Br J Surg 1992; 79:221–3
Laurent C, Sa Cunha A, Couderc P, et al. Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases. Br J Surg 2003; 90:1131–6
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Viganò, L., Ferrero, A., Lo Tesoriere, R. et al. Liver Surgery for Colorectal Metastases: Results after 10 Years of Follow-Up. Long-Term Survivors, Late Recurrences, and Prognostic Role of Morbidity. Ann Surg Oncol 15, 2458–2464 (2008). https://doi.org/10.1245/s10434-008-9935-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-008-9935-9