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Timing of Resection of Liver Metastases Synchronous to Colorectal Tumor: Proposal of Prognosis-Based Decisional Model

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Abstract

Background

Timing of hepatectomy for synchronous metastases of colorectal cancer is still debated. The aim of this retrospective study was to analyze prognostic factors after synchronous and delayed liver resections to define selection criteria for choosing timing of hepatectomy.

Methods

The study was performed on 127 patients with synchronous metastases undergoing radical hepatectomy. We divided patients according to the timing of hepatectomy: 70 synchronous (group A) and 57 delayed (group B).

Results

Overall survival was similar between the two groups (5-year survival 30.8% vs. 32.0% A vs. B, P = .406). The multivariate analysis evidenced four independent prognostic factors in group A: male sex (P = .04), T4 (P = .0035), more than three metastases (P = .0001), and metastatic infiltration of nearby structures (P < .0001). There were no statistically significant prognostic factors in group B. Patients with more than three metastases had a significantly worse survival in group A than in group B (3-year survival, 15.0% vs. 34.3%, P = .007); similarly, borderline significant difference was encountered in patients with T4 primary tumor (3-year survival, 16.7% vs. 60%, P = .064)

Conclusions

Patients with liver metastases synchronous with colorectal cancer with T4 primary tumor, metastasis infiltration of neighboring structures, and especially with more than three metastases should receive neoadjuvant chemotherapy before liver resection.

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Acknowledgments

Study conception and design: Luca Viganò, Alessandro Ferrero, Lorenzo Capussotti; acquisition of data: Roberto Lo Tesoriere, Dario Ribero; analysis and interpretation of data: Luca Vigano’, Alessandro Ferrero, Roberto Lo Tesoriere; drafting of manuscript: Luca Vigano’, Dario Ribero, Roberto Polastri; critical revision: Lorenzo Capussotti, Alessandro Ferrero, Roberto Polastri; supervision: Lorenzo Capussotti.

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Authors and Affiliations

  1. Unit of Surgical Oncology, Institute for Cancer Research and Treatment, Strada Provinciale 142 km 3,95 10060, Candiolo, Torino, Italy

    Lorenzo Capussotti MD, Luca Vigano’ MD, Alessandro Ferrero MD, Roberto Lo Tesoriere MD, Dario Ribero MD & Roberto Polastri MD

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  1. Lorenzo Capussotti MD
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  2. Luca Vigano’ MD
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  3. Alessandro Ferrero MD
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  4. Roberto Lo Tesoriere MD
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  5. Dario Ribero MD
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  6. Roberto Polastri MD
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Correspondence to Lorenzo Capussotti MD.

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Capussotti, L., Vigano’, L., Ferrero, A. et al. Timing of Resection of Liver Metastases Synchronous to Colorectal Tumor: Proposal of Prognosis-Based Decisional Model. Ann Surg Oncol 14, 1143–1150 (2007). https://doi.org/10.1245/s10434-006-9284-5

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  • DOI: https://doi.org/10.1245/s10434-006-9284-5

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